Supplementary Material for: Metamorphopsia with SMART syndrome: A case report.

Introduction: SMART syndrome is a rare complication of brain radiotherapy. This is the first described presentation of SMART syndrome with metamorphopsia which responded to Aspirin, Verapamil and high dose L-Arginine therapy.

Case presentation: A 43 year old man presented with three weeks of migraine headaches with metamorphopsia and complex visual hallucinations affecting the left lower quadrant of both visual fields. This occurred on a background of high dose radiotherapy for right cerebellar astrocytoma 32 years ago. MRI brain demonstrated unilateral gyriform enhancement and FLAIR hyperintense cortical swelling in the right occipital lobe consistent with SMART syndrome.

Conclusion: Unusual presentations of SMART syndrome exist and require consideration in all patients with focal neurological deficit post-brain radiotherapy. Validated diagnostic and treatment modalities for SMART syndrome are urgently required.

引言：SMART综合征是一种罕见的脑放疗并发症。本研究首次报道了伴视物变形症（metamorphopsia）的SMART综合征病例，该病例经阿司匹林（Aspirin）、维拉帕米（Verapamil）及大剂量L-精氨酸（L-Arginine）治疗后获得良好响应。

病例报告：一名43岁男性患者，因3周来出现偏头痛伴视物变形症及累及双眼左下视野的复杂视幻觉就诊。患者32年前因右侧小脑星形细胞瘤（astrocytoma）接受过大剂量放疗。颅脑磁共振成像（Magnetic Resonance Imaging, MRI）检查显示，右侧枕叶可见单侧脑回样强化及FLAIR（Fluid-Attenuated Inversion Recovery）序列高信号皮质肿胀，符合SMART综合征的影像学特征。

结论：SMART综合征存在不典型临床表现，所有脑放疗后出现局灶性神经功能缺损的患者均需将该病纳入鉴别诊断范围。目前亟需经过验证的SMART综合征诊断及治疗方案。