@article {Black, author = {D.F. Black and J.M. Morris and E.P. Lindell and K.N. Krecke and G.A. Worrell and J.D. Bartleson and D.H. Lachance}, title = {Stroke-Like Migraine Attacks after Radiation Therapy (SMART) Syndrome Is Not Always Completely Reversible: A Case Series}, year = {2013}, doi = {10.3174/ajnr.A3602}, publisher = {American Journal of Neuroradiology}, abstract = {SUMMARY: We retrospectively reviewed clinical and imaging findings in 11 patients with stroke-like migraine attacks after radiation therapy (SMART) syndrome to better understand this disorder previously thought to be reversible. Six men and 5 women had complex bouts of neurologic impairment beginning, on average, 20 years after cerebral irradiation. All had characteristic, unilateral gyriform enhancement on MR imaging that developed within 2{\textendash}7 days and typically resolved in 2{\textendash}5 weeks. Unlike prior reports, 45\% had incomplete neurologic recovery manifesting as dysphasia, cognitive impairment, or hemiparesis. The remaining 55\% recovered completely over an average of 2 months. Three of 11 patients developed cortical laminar necrosis. Brain biopsies in 4 of 11 did not demonstrate a specific pathologic substrate. These additional 11 patients contribute to the understanding of variability in stroke-like migraine attacks after radiation therapy syndrome, which often but not uniformly manifests with headaches and seizures, demonstrates a typical evolution of imaging findings, and may result in permanent neurologic and imaging sequelae. Abbreviations SMARTstroke-like migraine attacks after radiation therapyCLNcortical laminar necrosisCJDCreutzfeldt-Jakob diseasePIPGperi-ictal pseudoprogression}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/early/2013/06/20/ajnr.A3602}, eprint = {https://www.ajnr.org/content/early/2013/06/20/ajnr.A3602.full.pdf}, journal = {American Journal of Neuroradiology} }