Protracted and incomplete language recovery from SMART syndrome: a case report

ABSTRACT

Background: Stroke-like migraine attacks after radiation therapy – also known as SMART syndrome – constitute a rare condition characterised by headache, seizures, vision abnormalities, hemiparesis, and aphasia. The condition usually resolves within a few days or weeks with little to no residual impairment; however, recovery in some cases is protracted and incomplete.

Aims: The purpose of this case report was to describe the one-year progression of language in a person, GB, with slow recovery from SMART syndrome.

Methods & Procedures: GB was diagnosed with SMART syndrome at 39 years of age. Formal and informal assessments occurred at six, 11, 18, 29, and 52 weeks post-onset of SMART syndrome. Standardised assessment involved administration of portions of the Western Aphasia Battery – Revised, and informal assessment took the form of written and spoken language sample analyses.

Outcomes & Results: Initial evaluation at two weeks post-onset revealed global aphasia. This evolved into severe Wernicke’s aphasia by six weeks post-onset. Repeated evaluation over subsequent months revealed gradual improvement but continuing and substantial language impairment. At one-year post-onset, GB displayed anomic aphasia and persistent reading and writing deficits.

Conclusions: Substantial language recovery from SMART syndrome can occur beyond the initial few months post-onset. Documentation of the nature and extent of language impairment provides a starting point for developing and refining efficacious treatment protocols.

KEYWORDS:

• Aphasia
• language recovery
• migraines

Acknowledgments

We thank Carly Dinnes, Ph.D., for serving as a second professional performing language analysis procedures for reliability purposes.

Disclosure statement

Both authors were employed by one of the facilities at which the participant described in this manuscript received treatment.

Additional information

Funding

No funding supported this research.