ejm Ege Tıp Dergisi 1016-9113 2147-6500 Ege University 10.19161/etd.1288812 Neurology and Neuromuscular Diseases Health Care Administration Nöroloji ve Nöromüsküler Hastalıklar Sağlık Kurumları Yönetimi Opere Edilmiş ve Radyoterapi Almış Oligodendrogliom Olgusunda Nöbet Ve Hemiplejiyle Prezente Olan SMART sendromu Subacute Onset Seizures and Hemiplegia in an Operated and Radiated Oligodendroglioma Case: SMART Syndrome. https://orcid.org/0000-0002-8180-569X Dinçer Göktuğ EGE UNIVERSITY, EGE FACULTY OF MEDICINE https://orcid.org/0000-0002-9095-3184 Tombak Onur EGE UNIVERSITY, EGE FACULTY OF MEDICINE https://orcid.org/0000-0003-4870-3154 Gökçay Figen EGE UNIVERSITY, EGE FACULTY OF MEDICINE https://orcid.org/0000-0003-1194-3971 Acarer Ahmet EGE UNIVERSITY, EGE FACULTY OF MEDICINE https://orcid.org/0000-0003-4201-5449 Kitiş Ömer EGE UNIVERSITY, EGE FACULTY OF MEDICINE 06 10 2024 63 2 310 312 05 22 2023 10 17 2023 Copyright © 1962, Ege Journal of Medicine 1962 Ege Journal of Medicine

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.

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.

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