January 2021
Description
Images
Discussion
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)
Original
Captions
Right parietotemporal FLAIR and diffusion cortical hyperintensity. Gyriform enhancement is demonstrated in the contrast enhanced MRI, with radiation induced meningioma and radiation induced white matter changes.
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.
Good case… !!! Hoping to see more such cases in the coming month..