Stroke-Like Migraine Attacks After Radiation Therapy
Summary
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare, delayed complication observed in patients who have undergone cranial irradiation. Characterised by migraine-like headaches, focal neurological deficits such as hemiparesis or aphasia, seizures and variable visual disturbances, the syndrome can manifest months to decades after treatment. Magnetic resonance imaging typically reveals transient, unilateral cortical gyriform enhancement and subcortical white matter changes that resolve over days to weeks, although some patients sustain permanent deficits. The underlying mechanisms remain incompletely understood but are thought to involve radiation-induced endothelial injury, disruption of the blood–brain barrier and cortical spreading depression. Distinction from tumour recurrence, stroke and infectious or demyelinating processes is critical to avoid unnecessary interventions. Management centres on symptomatic relief, seizure control and corticosteroid administration, with emerging evidence that early steroid therapy may improve outcomes. Awareness of SMART syndrome is vital in long-term follow-up of brain tumour survivors to ensure prompt recognition and appropriate supportive care.
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Stroke-Like Migraine Attacks After Radiation Therapy publication trend
The graph below shows the total number of articles in stroke-like migraine attacks after radiation therapy across all publications each year (not limited to Nature Index journals).
Technical terms
SMART syndrome: A delayed radiation-induced condition marked by migraine-like headaches, focal neurological deficits and transient cortical MRI abnormalities.
Gyriform enhancement: Ribbon-like cortical contrast uptake on MRI, reflecting focal blood–brain barrier disruption.
Restricted diffusion: Reduced water molecule movement on diffusion-weighted MRI, indicating cytotoxic oedema or acute injury.
Cortical laminar necrosis: Layer-specific neuronal death in the cerebral cortex, visible as high signal intensity on certain MRI sequences.
References
- Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series. American Journal of Neuroradiology (2013).
- Stroke-Like Migraine Attacks After Radiation Therapy Syndrome. Ochsner Journal (2020).
- Prognostic Factors of Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome. American Journal of Neuroradiology (2022).
- Comprehensive Update and Review of Clinical and Imaging Features of SMART Syndrome. American Journal of Neuroradiology (2023).
- Early-onset stroke-like migraine attacks after radiation therapy syndrome: A case report and review of the literature. Journal of Clinical Neuroscience (2024).
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