# January 2021

- Link: https://isnr.in/january-2021/
- Published: 2021-01-31T13:27:08+05:30
- Author: ISNR

## January 2021

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)

[⌊Case of the Month January 2021⌉⌊Case of the Month January 2021⌉[

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.