Clinical Presentation and Management of SMART Syndrome

Stroke-like migraine attacks after radiation therapy (SMART) syndrome represents a rare but serious condition manifesting years after cranial radiation therapy (RT).1 Characterized by migraine-type headaches, stroke-like deficits, seizures, and MRI abnormalities, including cortical gyriform enhancement in irradiated brain regions, SMART is diagnostically and therapeutically challenging.2-6 Distinction from tumor progression is difficult and treatment options are limited.2 Although frequently reversible,5 SMART episodes can recur6 and effectuate persistent neurologic or imaging sequelae.3