Brain Magnetic Resonance Spectroscopy Findings in the Stroke-like Migraine Attacks after Radiation Therapy (SMART) Syndrome

J Neuroimaging. 2015 Nov-Dec;25(6):1056-8. doi: 10.1111/jon.12227. Epub 2015 Feb 19.


A 41-year-old male presented with an acute onset of headache, confusion, seizures, and unilateral focal neurological deficit 25 years after receiving whole-brain radiation therapy to treat a cerebellar medulloblastoma. Brain magnetic resonance imaging (MRI) demonstrated a thick unilateral parieto-occipital cortical contrast enhancement. A diagnosis of "Stroke-like Migraine Attacks after Radiation Therapy" (SMART) syndrome was made. Here, we describe the brain MR spectroscopy findings of SMART, showing a decrease in N-acetyl-aspartate and increased levels of creatine and choline, corresponding with neuronal destruction or transient neuronal impairment with mild nonspecific gliosis. The absence of a lactate peak suggests that mitochondrial dysfunction, vasospasm or ischemic mechanisms were not involved.

Keywords: Creatine; SMART; magnetic resonance spectroscopy; radiation therapy; stroke-like migraine attacks after radiation therapy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Brain / diagnostic imaging*
  • Cerebellar Neoplasms / radiotherapy
  • Humans
  • Magnetic Resonance Spectroscopy
  • Male
  • Medulloblastoma / radiotherapy
  • Migraine Disorders / diagnostic imaging*
  • Migraine Disorders / etiology
  • Radiotherapy / adverse effects*