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SMART syndrome: two cases highlighting a complex and rare complication of brain irradiation
  1. Hanne Blakstad1,2,
  2. Christine Wohlleben3,
  3. Cathrine Saxhaug4 and
  4. Petter Brandal1,5
  1. 1Department of Oncology, Oslo University Hospital, Oslo, Norway
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Neurology, Akershus University Hospital, Lorenskog, Norway
  4. 4Department of Radiology, Oslo University Hospital, Oslo, Norway
  5. 5Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Hanne Blakstad; hanbla{at}


Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare complication of radiotherapy with complex neurological impairment. Patients present with neurological symptoms and signs such as migraine, hemianopsia, hemiplegia, aphasia and/or seizures—without recurrence of neoplastic disease. In this report, we describe SMART syndrome in two adult patients 4 and 14 years following brain irradiation, respectively.

  • neurooncology
  • neuroimaging
  • CNS cancer
  • radiotherapy

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  • Contributors All authors, HB, CW, CS and PB, have participated in care and/or second opinion of the patients and agreed to publish these case reports. The manuscript was drafted by the first author HB. CS acquired the images seen. The manuscript was revised and critically reviewed by CW, CS and PB before being submitted by HB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.