PMC10327860_01
Axial and sagittal CT section shows corticopial enhancement in the left posterior frontal lobe surrounding the resection cavity.
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F1
As part of the diagnostic workup of the patient, a cerebral computed tomography (CT) scan was performed which demonstrated corticopial enhancement in the left frontal lobe located posteriorly to the resection cavity (Figure 1).
Brain MRI at presentation with no evidence of restriction of diffusion (A). Marked left posterior frontal gyral edema on axial FLAIR (B) associated with cortical gyriform gadolinium enhancement on coronal and sagittal T1-weighted (C-D).
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F2
An additional magnetic resonance imaging (MRI) examination was performed the next day which demonstrated slight edema of the left frontal gyri, hyperintensity on T2/FLAIR imaging, persistence of the corticopial enhancement without restricted diffusion or significant hyperperfusion (Figure 2).
Radiotherapy dose distribution with correlating axial post-contrast T1-weighted image demonstrating the cortical enhancement at presentation.
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F3
The previous history of RT to this area of the brain (Figure 3) and the stroke like presentation combined with the presence of headache were compatible with the diagnosis of SMART syndrome.
Complete resolution of findings one month later on axial FLAIR (A), coronal and sagittal postcontrast T1-weighted imaging (B - C).
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F4
MRI was repeated one month later and showed complete disappearance of the cortico-meningeal enhancement (Figure 4) and lack of diffusion restriction.