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Neuropediatrics 2016; 47(04): 259-262
DOI: 10.1055/s-0036-1582246
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Cerebral Hyperperfusion in a Child with Stroke-Like Migraine Attacks after Radiation Therapy Syndrome

Didem Ardicli
1   Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Rahsan Gocmen
2   Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Kader K. Oguz
2   Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Ali Varan
3   Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Dilek Yalnizoglu
1   Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

05 November 2015

08 March 2016

Publication Date:
22 April 2016 (online)

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Abstract

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare complication of cranial radiotherapy characterized by migraine-like headache and transient neurological deficits with typical gyriform enhancement on magnetic resonance imaging (MRI). Potential underlying mechanisms are endothelial damage or dysfunction, vascular instability, vasospasm and, neuronal dysfunction.

We report an 11-year-old girl with a primary diagnosis of medulloblastoma presented with acute-onset severe headache and left-sided weakness, 20 months after completing cranial radiotherapy. MRI demonstrated unilateral cortical swelling and concomitant leptomeningeal, gyral contrast enhancement, and MR perfusion imaging showed increased cortical perfusion in the right temporo-parieto-occipital region. Her symptoms resolved spontaneously over several days.

SMART syndrome appears to be a reversible, long-term complication of cranial radiotherapy. So far, a limited number of pediatric patients with SMART syndrome have been reported. Prompt recognition of clinical signs and radiological imaging of SMART syndrome may help prevent unnecessary interventions and initiate appropriate diagnostic workup and management.

Keywords

SMART syndrome - children - radiotherapy
 

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