Case Report: SMART syndrome mimicking Todd’s paralysis after meningioma irradiation - Takeaways - MDSpire
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Case Study: SMART Syndrome Presenting as Todd’s Paralysis Following Meningioma Radiation Therapy

  • By

  • Anneliese Troidle

  • Danzhu Zhao

  • Charles Rutter

  • Lisa Knopf

  • Narinder Maheshwari

  • August 19, 2026

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  • 1

    SMART syndrome is a rare delayed effect of cerebral irradiation, typically presenting with stroke-like symptoms after a mean latency of 11.2 years.

  • 2

    The case involves a 59-year-old male with anaplastic meningioma who developed Todd’s paralysis and seizures following radiation therapy.

  • 3

    Neuroimaging revealed sulcal enhancement and cortical hyperintensity in the previously irradiated area, consistent with SMART syndrome.

  • 4

    The patient required a prolonged dexamethasone taper and calcium channel blocker treatment due to persistent neurologic deficits.

  • 5

    A follow-up MRI showed resolution of enhancement and clinical improvement, highlighting the need for vigilance in post-radiation patients.

Original Source(s)

Case Report: SMART syndrome mimicking Todd’s paralysis after meningioma irradiation

  • by Anneliese Troidle, Danzhu Zhao, Charles Rutter, Lisa Knopf, Narinder Maheshwari

  • August 19, 2026

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