"non-convulsive status epilepticus and repeated focal seizures: may demonstrate similar imaging and clinical features, SMART alterations typically last for weeks while post-critical changes resolve quicker 10"
"SMART syndrome, an acronym for stroke-like migraine attacks after radiation therapy syndrome, is an uncommon delayed complication of cerebral radiation therapy. It is probably a more severe manifestation of peri-ictal pseudoprogression (PIPG)."
"SMART syndrome is encountered in individuals who have received therapeutic cerebral irradiation (>50 Gy), typically years later (6-30 years) 1,2,6. In most instances, patients have a history of seizures 6."
"The diagnosis of SMART syndrome is essentially one of exclusion and can only be entertained in the correct clinical setting. Various criteria have been proposed 2,8 although these are evolving. They can be generally summarised as follows:"
"The precise mechanism that underlies SMART syndrome is uncertain and biopsies obtained from some patients do not reveal specific abnormalities above and beyond those expected in previously irradiated brain 6."
"It is hypothesised that SMART syndrome represents an exacerbation of normal postictal phenomena due to prior radiotherapy 6."
"MRI is the modality of choice to investigate SMART syndrome 14. Importantly, imaging abnormalities do not precede or coincide with symptom onset; rather, it takes 2-7 days for imaging abnormalities to develop 6. As such, if imaging is performed early, a repeat scan is advisable a week later to have a better chance of identifying abnormalities. Changes related to SMART syndrome usually last for weeks 10."
"MRI is the modality of choice to investigate SMART syndrome 14. Importantly, imaging abnormalities do not precede or coincide with symptom onset; rather, it takes 2-7 days for imaging abnormalities to develop 6. As such, if imaging is performed early, a repeat scan is advisable a week later to have a better chance of identifying abnormalities. Changes related to SMART syndrome usually last for weeks 10."
"The hallmark of SMART syndrome is prominent gyral enhancement with mild mass effect cortical thickening (hyperintense in T2 and FLAIR) with or without diffusion restriction 14. It is usually unilateral and confined to the areas of the brain that underwent irradiation."
"SWI: foci of susceptibility artifacts may be seen, thought to be related to cavernous malformations induced by remote radiotherapy rather than SMART syndrome directly 14"
"PWI"
"SMART syndrome may be self-limiting, with gradual and complete resolution over the course of several weeks; typically occurring within 2-5 weeks but can take up to 3 months 4,6. However, incomplete clinical recovery is not uncommon (up to ~45% of subjects in one series 6). In patients without self-limited disease, antiseizure medications and calcium channel blockers may help to ameliorate symptoms 9."
"non-convulsive status epilepticus and repeated focal seizures: may demonstrate similar imaging and clinical features, SMART alterations typically last for weeks while post-critical changes resolve quicker 10"
"MRI is the modality of choice to investigate SMART syndrome 14. Importantly, imaging abnormalities do not precede or coincide with symptom onset; rather, it takes 2-7 days for imaging abnormalities to develop 6. As such, if imaging is performed early, a repeat scan is advisable a week later to have a better chance of identifying abnormalities. Changes related to SMART syndrome usually last for weeks 10."
"SMART syndrome may be self-limiting, with gradual and complete resolution over the course of several weeks; typically occurring within 2-5 weeks but can take up to 3 months 4,6. However, incomplete clinical recovery is not uncommon (up to ~45% of subjects in one series 6). In patients without self-limited disease, antiseizure medications and calcium channel blockers may help to ameliorate symptoms 9."