RESUMEN
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare delayed complication of cranial radiotherapy, that may present decades after brain irradiation. Here we present a case of 41-year old patient with a history of grade 3 oligodendroglioma, epilepsy and migraine, 26 years after brain radiation therapy, who was admitted with right hemicranial headache, nausea, left homonymous hemianopsia, weakness of the left arm and left-sided hemihypesthesia. After considering alternate diagnoses, we ultimately diagnosed SMART syndrome. Despite its rare occurrence and unknown pathophysiology, there are more case reports of SMART syndrome reported due to advancements in oncology treatment and increasing patients' survival rates. Therefore, diagnosis of SMART syndrome should always be considered in patients with a history of cranial radiation presenting with focal neurologic deficits and migraine, especially with a change in pattern of their usual migraine attack.
RESUMEN
Combined central and peripheral demyelination (CCPD) is a rare autoimmune neurologic disease, characterized by immune-mediated damage of myelin sheath at central and peripheral levels of the nervous system. The current knowledge about this disorder is only limited, mainly due to the low incidence of the disease. According to previous studies, CCPD has a very heterogeneous course, insufficient therapeutic response, and an unfavorable prognosis. We report on the 37-year-old patient with a coincidence of demyelinating lesions in the brain fulfilling current McDonald's diagnostic criteria for multiple sclerosis, as well as the presence of an atypical variant of chronic inflammatory demyelinating polyneuropathy (CIDP) - multifocal acquired demyelinating sensory-motor neuropathy (MADSAM), as a subtype of combined central and peripheral demyelination (CCPD).