Opere Edilmiş ve Radyoterapi Almış Oligodendrogliom Olgusunda Nöbet Ve Hemiplejiyle Prezente Olan SMART sendromu
Öz
Giriş: Radyoterapinin geç gecikmiş komplikasyonlarından olan SMART sendromu; baş ağrısı, fokal nöbet ve nörolojik defisitler ile karakterize subakut gelişimli bir tablodur. Klinik tablo ile beraber spesifik görüntüleme bulguları olan giral leptomeningeal kontrastlanma, kortikal gri cevherde kalınlaşma ve FLAIR’de hiperintens görünüm ile tanısı konabilir.
Olgu Sunumu: 10 yıl önce sağ paryetooksipital anaplastik oligodendrogliom nedenli opere edilmiş, kemoterapi ve radyoterapi uygulanmış 58 yaşında erkek hasta subakut seyirli sol fokal başlangıçlı sekonder jeneralize nöbetler, baş ağrısı ve sol hemiparezi gelişmesi nedeniyle kliniğimize yatırıldı. Kan ve beyin omurilik sıvısı bakısında özellik olmayan, manyetik rezonans görüntülemesinde nüks saptanmayan hastada sağ frontoparyetotemporal leptomeningeal giral kontrastlanma ve FLAIR’de hiperintens kortikal kalınlaşma saptanması sonucu SMART sendromu tanısı kondu ve steroid tedavisi uygulandı. Tedaviden yarar gören hastanın klinik ve radyolojik bulgularında belirgin düzelme oldu.
Tartışma: SMARTsendromu tedavisinde steroid tedavisi önerilmekle beraber tedavisiz olarak da tablonun kendini sınırladığı bildirilmiştir. Nadir görülmesi nedeniyle patogenezine ve nasıl yönetileceğine dair hala pek çok açıklanmamış nokta bulunmaktadır.
Sonuç: Radyoterapi almış tümör olgularında yıllar sonra gelişen progresyon durumunda olası tüm patolojiler dışlandıktan sonra SMART sendromu tanısı konması prognozu öngörme açısından önemlidir.
Anahtar Kelimeler
Kaynakça
- Gorbunov NV, Kiang JG. Brain Damage and Patterns of Neurovascular Disorder after Ionizing Irradiation. Complications in Radiotherapy and Radiation Combined Injury. Radiat Res. 2021 Jul 1;196(1):1-16.
- Dominguez M, Malani R. Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Comprehensive Review. Curr Pain Headache Rep. 2021 Mar 24;25(5):33.
- Bozkurt S, Toprak B, Yıldırım HÇ, et al. SMART syndrome: a case report. Acta Neurol Belg. 2023;123(3):1137-1140.
- Singh TD, Hajeb M, Rabinstein AA, Kunchok AC, Pittock SJ, Krecke KN, Bartleson JD, Black DF. SMART syndrome: retrospective review of a rare delayed complication of radiation. Eur J Neurol. 2021 Apr;28(4):1316-1323.
- de Oliveira Franco Á, Anzolin E, Schneider Medeiros M, Machado Castilhos R, Targa Martins R, Moser Filho HL. SMART Syndrome Identification and Successful Treatment. Case Rep Neurol. 2021 Jan 25;13(1):40-45.
- Patel UK, Patel K, Malik P, Elkady A, Patel N, Lunagariya A. Stroke-like migraine attacks after radiation therapy (SMART) syndrome-a case series and review. Neurol Sci. 2020 Nov;41(11):3123-3134.
- Armstrong AE, Gillan E, DiMario FJ Jr. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients. J Child Neurol. 2014 Mar;29(3):336-41.
- Rocha R, Ribeiro L, Correia F. SMART syndrome: a late-onset and not always reversible complication of radiotherapy. BMJ Case Rep. 2021 Apr 15;14(4):e241748.
- Angelidis P, Saleh C, Jaszczuk P, Seyam M, Ebner KA, Hund-Georgiadis M. SMART Syndrome (Stroke-like migraine attacks after radiation therapy): When to suspect it? Surg Neurol Int. 2021 Nov 16;12:561.
- Nagysomkuti Mertse N, Müri R. Case Report: SMART ANTON: Anton-Babinski Syndrome in Stroke-Like Migraine Attacks (SMART) After Radiation Therapy: Two Rare Syndromes, One Case. Front Neurol. 2022 Jun 27;13:887287.
Subacute Onset Seizures and Hemiplegia in an Operated and Radiated Oligodendroglioma Case: SMART Syndrome.
Öz
Introduction: SMART syndrome, a late delayed complication of crainal radiotherapy, is characterized with headache, seizures and focal neurologic deficits. Specific imaging findings of SMART syndrome are gyral leptomeningeal contrast enhancement and FLAIR hyperintense cortical thickening. A patient with subacute specific symptoms and imaging findings can be diagnosed with SMART.
Case report: A 58 year old male patient with a history of operated right parietooccipital anaplastic oligodendroglioma, chemotherapy and radiotherapy presented with subacute onset of left focal secondary generalized seizures, headache and left hemiparesis. Blood and cerebrospinal fluid examination showed no pathological finding. Magnetic resonance imaging (MRI) was conducted. No finding of tumour relapse were present on MRI, however right frontoparietotemporal gyral leptomeningeal contrast enhancement and FLAIR hyperintense cortical thickening was detected. A diagnosis of SMART was made and after steroid therapy the patient recovered clinically and radiologically.
Discussion: Steroid therapy is recommended for SMART patients, however with or without corticosteroids, this disease is self-limiting. There are many unanswered questions about pathogenesis and management of SMART due to the fact that this disease is very rare and there are little literature on this subject.
Conclusion: Diagnosing SMART in irradiated tumour cases with progression after years when other possible pathologies are excluded is important to predict the prognosis of the patient.
Anahtar Kelimeler
Kaynakça
- Gorbunov NV, Kiang JG. Brain Damage and Patterns of Neurovascular Disorder after Ionizing Irradiation. Complications in Radiotherapy and Radiation Combined Injury. Radiat Res. 2021 Jul 1;196(1):1-16.
- Dominguez M, Malani R. Stroke-Like Migraine Attacks After Radiation Therapy (SMART) Syndrome: A Comprehensive Review. Curr Pain Headache Rep. 2021 Mar 24;25(5):33.
- Bozkurt S, Toprak B, Yıldırım HÇ, et al. SMART syndrome: a case report. Acta Neurol Belg. 2023;123(3):1137-1140.
- Singh TD, Hajeb M, Rabinstein AA, Kunchok AC, Pittock SJ, Krecke KN, Bartleson JD, Black DF. SMART syndrome: retrospective review of a rare delayed complication of radiation. Eur J Neurol. 2021 Apr;28(4):1316-1323.
- de Oliveira Franco Á, Anzolin E, Schneider Medeiros M, Machado Castilhos R, Targa Martins R, Moser Filho HL. SMART Syndrome Identification and Successful Treatment. Case Rep Neurol. 2021 Jan 25;13(1):40-45.
- Patel UK, Patel K, Malik P, Elkady A, Patel N, Lunagariya A. Stroke-like migraine attacks after radiation therapy (SMART) syndrome-a case series and review. Neurol Sci. 2020 Nov;41(11):3123-3134.
- Armstrong AE, Gillan E, DiMario FJ Jr. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients. J Child Neurol. 2014 Mar;29(3):336-41.
- Rocha R, Ribeiro L, Correia F. SMART syndrome: a late-onset and not always reversible complication of radiotherapy. BMJ Case Rep. 2021 Apr 15;14(4):e241748.
- Angelidis P, Saleh C, Jaszczuk P, Seyam M, Ebner KA, Hund-Georgiadis M. SMART Syndrome (Stroke-like migraine attacks after radiation therapy): When to suspect it? Surg Neurol Int. 2021 Nov 16;12:561.
- Nagysomkuti Mertse N, Müri R. Case Report: SMART ANTON: Anton-Babinski Syndrome in Stroke-Like Migraine Attacks (SMART) After Radiation Therapy: Two Rare Syndromes, One Case. Front Neurol. 2022 Jun 27;13:887287.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Nöroloji ve Nöromüsküler Hastalıklar, Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Haziran 2024 |
| Gönderilme Tarihi | 22 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2024Cilt: 63 Sayı: 2 |
