• J Neuroimaging · Nov 2015

    Case Reports

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

    • Emilio Gómez-Cibeira, Patricia Calleja-Castaño, Jesus Gonzalez de la Aleja, Fernando Sierra-Hidalgo, Juan Ruiz Morales, Elena Salvador-Alvarez, and Ana Ramos-Gonzalez.
    • Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
    • J Neuroimaging. 2015 Nov 1; 25 (6): 1056-8.

    AbstractA 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.Copyright © 2015 by the American Society of Neuroimaging.

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