Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Case Report With Vertigo, Dysmetria, And Impaired Tandem Gait

SMART syndrome is a rare, delayed complication of brain radiation. The acronym SMART stands for stroke-like migraine attacks following radiation therapy. This case is one of the first to describe episodic vertigo, dysmetria, and impaired tandem gait following proton beam radiotherapy for a craniopharyngioma. An 18-year-old male presented with migraine headaches, upper and lower limb weakness, episodic vertigo, and dysmetria with impaired tandem gait. This occurred following proton-beam radiotherapy, which was completed at around 11 years of age for recurrent craniopharyngioma. Magnetic resonance imaging (MRI) of the brain demonstrated a T1 hyperintense signal in the cortex of the right parietal and temporal lobes consistent with SMART syndrome. In addition, a subcortical hyperintense signal was seen in the right parietal, temporal, and frontal lobes. Atypical presentations of SMART syndrome are out there, and it is essential to recognize them in patients presenting with neurological symptoms following radiation therapy so that diagnosis and treatment can be done.