caa a22 4500 445807474 CHVBK 20180317145201.0 cr unu---uuuuu 170323e20110601xx s 000 0 eng 10.1007/s00415-010-5892-x doi (NATIONALLICENCE)springer-10.1007/s00415-010-5892-x SMART syndrome: a late reversible complication after radiation therapy for brain tumours [Elektronische Daten] [Joost Kerklaan, Geert Lycklama á Nijeholt, Ruud Wiggenraad, Bianca Berghuis, Tjeerd Postma, Martin Taphoorn] With intensified treatment leading to longer survival, complications of therapy for brain tumours are more frequently observed. Regarding radiation therapy, progressive and irreversible white matter disease with cognitive decline is most feared. We report on four patients with reversible clinical and radiological features occurring years after radiation for brain tumours, suggestive for the so called SMART syndrome (stroke-like migraine attacks after radiation therapy). All four patients (males, age 36-60 years) had been treated with focal brain radiation for a primary brain tumour or with whole-brain radiation therapy for brain metastases. Ranging from 2 to 10years following radiation therapy patients presented with headache and focal neurological deficits, suggestive for tumour recurrence. Two patients also presented with focal seizures. MRI demonstrated typical cortical swelling and contrast enhancement, primarily in the parieto-occipital region. On follow-up both clinical and MRI features improved spontaneously. Three patients eventually proved to have tumour recurrence. The clinical and radiological picture of these patients is compatible with the SMART syndrome, a rare complication of radiation therapy which is probably under recognized in brain tumour patients. The pathophysiology of the SMART syndrome is poorly understood but bears similarities with the posterior reversible encephalopathy syndrome (PRES). These four cases underline that the SMART syndrome should be considered in patients formerly treated with radiation therapy for brain tumours, who present with new neurologic deficits. Before the diagnosis of SMART syndrome can be established other causes, such as local tumour recurrence, leptomeningeal disease or ischemic disease should be ruled out. The Author(s), 2011 Reversible late effects nationallicence Radiation therapy nationallicence Brain tumours nationallicence Kerklaan Joost Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut Lycklama á Nijeholt Geert Department of Radiology, Medical Centre Haaglanden, The Hague, The Netherlands aut Wiggenraad Ruud Department of Radiotherapy, Medical Centre Haaglanden, The Hague, The Netherlands aut Berghuis Bianca Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut Postma Tjeerd Department of Neurology, VU University medical centre, Amsterdam, The Netherlands aut Taphoorn Martin Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut Journal of Neurology Springer-Verlag 258/6(2011-06-01), 1098-1104 0340-5354 258:6<1098 2011 258 415 https://doi.org/10.1007/s00415-010-5892-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00415-010-5892-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kerklaan Joost Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Lycklama á Nijeholt Geert Department of Radiology, Medical Centre Haaglanden, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Wiggenraad Ruud Department of Radiotherapy, Medical Centre Haaglanden, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Berghuis Bianca Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Postma Tjeerd Department of Neurology, VU University medical centre, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Taphoorn Martin Department of Neurology, Medical Centre Haaglanden, Postbus 432, 2501 CK, The Hague, The Netherlands aut NATIONALLICENCE 773 0- Journal of Neurology Springer-Verlag 258/6(2011-06-01), 1098-1104 0340-5354 258:6<1098 2011 258 415 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer