Case Study: SMART Syndrome Presenting as Todd’s Paralysis Following Meningioma Radiation Therapy
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By
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Anneliese Troidle
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Danzhu Zhao
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Charles Rutter
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Lisa Knopf
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Narinder Maheshwari
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August 19, 2026
Clinical Scorecard: Case Study: SMART Syndrome Presenting as Todd’s Paralysis Following Meningioma Radiation Therapy
At a Glance
| Category | Detail |
|---|
| Condition | SMART Syndrome |
| Key Mechanisms | Dysfunction of cerebrovascular autoregulation, neuronal impairment affecting the trigeminovascular system, cortical spreading depression, and seizure activity. |
| Target Population | Patients with a history of cerebral irradiation, particularly those treated for gliomas and medulloblastomas. |
| Care Setting | Neurology and radiation oncology departments. |
Key Highlights
- SMART syndrome presents with symptoms similar to stroke, seizures, and headaches.
- Mean latency for symptoms is approximately 11.2 years post-radiation.
- Diagnosis can be complex due to symptom overlap with recurrent neurologic deficits.
- Case involved a 59-year-old male with anaplastic meningioma and Todd’s paralysis.
- Multidisciplinary assessment led to a prolonged dexamethasone taper and continued antiepileptic treatment.
Guideline-Based Recommendations
Diagnosis
- Diagnosis of SMART syndrome is a diagnosis of exclusion.
Management
- Initiate corticosteroid treatment for symptomatic relief.
- Consider calcium channel blockers as part of management.
Monitoring & Follow-up
- Regular follow-up MRI to assess for resolution of symptoms and imaging findings.
Risks
- Potential for misdiagnosis due to symptom overlap with other neurological conditions.
Patient & Prescribing Data
Patients with a history of cerebral irradiation and subsequent neurologic symptoms.
Combination of corticosteroids and antiepileptic medications is essential for management.
Clinical Best Practices
- Maintain clinical vigilance in patients with a history of cerebral irradiation.
- Conduct thorough diagnostic assessments including neuroimaging and EEG.
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