Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare and delayed complication of cranial irradiation. Presenting years and even decades after brain radiotherapy, SMART syndrome is associated with a constellation of neurological symptoms, including severe headaches, episodic visual loss, stroke-like hemiparesis, sensory change and seizures. We describe a case of a male in his 60s who presented with acute onset hemiparesis, aphasia and altered sensation, as well as new recurrent and refractory seizure activity. The patient’s case is followed through his eventual diagnosis and successful treatment with high-dose pulse corticosteroids (1000 mg/day intravenous methylprednisolone for 3 days) as well as the long-term clinical and radiographical outcomes.
Liu et al. (2026) studied this question.