Longitudinal Imaging Findings in a Patient with SMART Syndrome Following Cranial Radiotherapy: A Case Study

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SMART syndrome is a delayed effect of cranial irradiation characterized by migraine-like headaches, seizures, and focal neurological deficits.
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A 48-year-old female patient experienced recurrent episodes of focal seizures and unilateral headaches 24 years post-radiotherapy for an anaplastic astrocytoma.
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MRI findings showed extensive unilateral gyriform cortical enhancement in the previously irradiated hemisphere, indicating possible SMART syndrome.
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Retrospective analysis revealed a milder cortical enhancement episode nine years prior, suggesting earlier manifestations of SMART syndrome.
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The presence of cavernous malformations in the patient aligns with chronic radiation-induced microvascular damage and supports a continuum of cortical vulnerability.

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