PT  - JOURNAL ARTICLE
AU  - Ota, Y.
AU  - Liao, E.
AU  - Shah, G.
AU  - Srinivasan, A.
AU  - Capizzano, A.A.
TI  - Comprehensive Update and Review of Clinical and Imaging Features of SMART Syndrome
AID  - 10.3174/ajnr.A7859
DP  - 2023 Jun 01
TA  - American Journal of Neuroradiology
PG  - 626--633
VI  - 44
IP  - 6
4099  - http://www.ajnr.org/content/44/6/626.short
4100  - http://www.ajnr.org/content/44/6/626.full
SO  - Am. J. Neuroradiol.2023 Jun 01; 44
AB  - SUMMARY: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a delayed complication of cranial irradiation, with subacute onset of stroke-like symptoms including seizures, visual disturbance, speech impairment, unilateral hemianopsia, facial droop, and aphasia, often associated with migraine-type headache. The diagnostic criteria were initially proposed in 2006. However, the diagnosis of SMART syndrome is challenging because clinical symptoms and imaging features of SMART syndrome are indeterminate and overlap with tumor recurrence and other neurologic diseases, which may result in inappropriate clinical management and unnecessary invasive diagnostic procedures. Recently, various imaging features and treatment recommendations for SMART syndrome have been reported. Radiologists and clinicians should be familiar with updates on clinical and imaging features of this delayed radiation complication because recognition of this entity can facilitate proper clinical work-up and management. This review provides current updates and a comprehensive overview of the clinical and imaging features of SMART syndrome.ALERTacute late-onset encephalopathy after radiation therapyATPadenosine triphosphateMELASmitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodesPIPGperi-ictal pseudoprogressionPRESposterior reversible encephalopathy syndromeROSreactive oxygen speciesSMARTstroke-like migraine attacks after radiation therapy