A 50 year old woman who underwent treatment for high grade pineal tumor. Presented with recurrent headache, seizures, visual disturbances and memory disturbances
Case contributed by –
Department of Imaging Sciences and Intervention Radiology, SCTIMST, Trivandrum (from ISNR 2020 online quiz)
Final diagnosis – SMART SYNDROME (Stroke like Migraine attacks with Radiation therapy) with a radiation induced meningioma.
- SMART syndrome Is a rare delayed complication of radiation therapy.
- It is characterized by transient reversible neurological symptoms.
- MRI usually demonstrates unilateral temporo parieto occipital cortex with cortical enhancement on contrast enhanced MRI images.
- Diagnostic criteria (Black et al 2006): 1) Remote history of cranial radiation; 2) prolonged and reversible unilateral cortical signs beginning years after radiation with manifestations like visuo-spatial deficit, confusion, hemiparesis, aphasia, seizures, headache; 3) Transient, diffuse, unilateral cortical gray matter enhancement sparing the white matter, 4)Not attributable to any other disorder.