Clinical Report: SMART Syndrome Presenting as Todd’s Paralysis Following Meningioma Radiation Therapy
Overview
This case study describes a 59-year-old male who developed SMART syndrome characterized by Todd's paralysis and seizures following radiation therapy for anaplastic meningioma. The diagnosis was confirmed through neuroimaging and clinical assessment.
Background
SMART syndrome is a rare delayed complication of cerebral irradiation, typically presenting with stroke-like symptoms, seizures, and headaches. It is primarily associated with gliomas and medulloblastomas, with some reports of occurrence in patients with meningiomas. The mean latency for symptom onset is approximately 11.2 years.
Data Highlights
No numerical data or trial data available in the article.
Key Findings
SMART syndrome can present with Todd's paralysis and focal epilepsy after radiation therapy.
The patient experienced a 10-minute seizure followed by prolonged neurological deficits lasting over 24 hours.
Neuroimaging revealed sulcal enhancement and hyperintensity within the prior radiation field.
A prolonged dexamethasone taper was required due to initial treatment failure.
Follow-up MRI indicated resolution of enhancement and clinical improvement.
Clinical Implications
Clinicians should consider SMART syndrome in patients with a history of cerebral irradiation who present with new neurological deficits.
Conclusion
This case illustrates the presentation of SMART syndrome in a patient with a history of cranial radiation therapy.
For patients who continue to have seizures despite appropriate anti-seizure medication therapy, timely referral for surgical evaluation can change the trajectory of care.
