Normal cerebrovascular reactivity in Stroke-like Migraine Attacks after Radiation Therapy syndrome

Clin Nucl Med. 2010 Aug;35(8):583-5. doi: 10.1097/RLU.0b013e3181e4db6f.


Stroke-like Migraine Attacks after Radiation Therapy (SMART) syndrome is a rare complication of cranial irradiation. Radiation is well-known to impair vascular vessel architecture and function. We investigated the hypothesis of radiation-induced cerebral vascular reserve dysfunction as the underlying mechanism of SMART. Interictal cerebrovascular reactivity was investigated using Tc-99m hexamethylpropyleneamine oxime-SPECT and acetazolamide challenge in 3 patients. We found interictal hypoperfusion and normal cerebrovascular reactivity in all patients. Neither ictal restriction of the apparent diffusion coefficient nor MR angiography abnormalities were observed. These findings do not support a vascular mechanism in SMART syndrome. Postradiation neuronal dysfunction may be the underlying mechanism. Further investigations on larger series are needed to confirm this hypothesis.

MeSH terms

  • Aged
  • Brain / blood supply*
  • Brain / diagnostic imaging
  • Female
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / diagnostic imaging
  • Migraine Disorders / etiology*
  • Migraine Disorders / physiopathology*
  • Radiotherapy / adverse effects*
  • Stroke*
  • Tomography, Emission-Computed, Single-Photon
  • Young Adult