Ataques de migraña tipo isquémico posterior a radioterapia (SMART): hallazgos en RMN

Stroke-Like Migraine Attacks after Radiation Therapy (SMART), is characterized by complex migraines with focal neurologic symptoms that usually occur in patients with a history of Central Nervous System malignancy, several years after Radiotherapy. A thirty four year-old male presented in 1996 with 12 y/o, a Primary Brain Mesenchyme Condrosarcoma of the left parietal lobe treated with surgery and Radiotherapy. Ten years later he presented with severe migraine followed by hemiparesis, right hand and arm focal motor seizures, hemiplegia and aphasia, requiring medical treatment with no evidence of neurological lesion. Since then, recurrent episodes with variable intensity of severe headaches, photophobia, and right hemiparesis. Right focal arm seizures, hemiplegia, and aphasia in occasions. Complete recovery between 5 to 21 days. He described 10 to 35 events per year. No evidence of tumor recurrence during follows up. He developed mild progressive right arm atrophy and muscle weakness. In 2014, MRI of the brain showed a typical pattern of discrete cortical hyper intensity on FLAIR and T2 sequences with extensive cortical gyri gadolinium enhancement on T1 sequences of the left temporal, occipital and parietal lobes had been identified during the symptoms. Complete resolution of these findings on MRI, 2 to 3 weeks after this episode. SMART usually presents in patients diagnosed with primary malignant brain tumors treated with Radiotherapy, with the typical gyri gadolinium enhancement on T1 sequences, years after treatment. Its incidence in the last decade has increased proportionally to cancer survival. Early recognition is important to avoid unnecessary interventions during follow-up. Ataques de migraña tipo isquémico posterior a radioterapia (SMART), caracterizado por migrañas complejas y síntomas neurológicos focales recurrentes en pacientes con antecedentes de neoplasias malignas cerebrales tratados con radioterapia. Masculino de 34 años diagnosticado a los 12 años (1996) de Condrosarcoma mesénquimatico cerebral primario del lóbulo parietal izquierdo, tratado con cirugía y radioterapia. Diez años después presenta ataque de migraña con parestesias y convulsión focal motora en brazo derecho, hemiplejia y afasia, requiriendo hospitalización y tratamiento médico, sin evidencia de déficit neurológico. Posteriormente episodios recurrentes, de intensidad variable, con cefalea intensa, fotofobia, parestesia y paresia en hemicuerpo derecho. En oportunidades, hemiple