Neurological Puzzles After Radiotherapy: Mysterious Clues of Smart Syndrome, Two Case Reports

SMART (stroke-like migraine attacks after radiation therapy) syndrome is a rare neurological disorder characterized by stroke-like symptoms and migraine-like headaches years after brain radiotherapy. Its pathophysiology remains unclear but is linked to vascular damage, inflammation, and mitochondrial dysfunction. This study presents two cases, emphasizing clinical and radiological findings. MRI is crucial for diagnosis, often showing transient cortical hyperintensities and contrast enhancement. Misdiagnosis as stroke or tumor recurrence may lead to unnecessary interventions. Increasing awareness is essential for accurate diagnosis and management. Further research is needed to refine diagnostic criteria and optimize treatment strategies for this rare but significant condition.