Investigators at the Children's Hospital of Philadelphia, PA, performed a retrospective study of 265 children with brain tumors who received cranial irradiation and developed severe recurrent headache. Review of medical records found that stroke or TIA occurred in 7/37 (19%) with severe headache compared to 6/228 (3%) without these events, when followed for a median of 6.0 years (p=0.003). Median time for a first neurovascular event was 4.9 years (range 1.7-5.5 years). 
COMMENT. Severe recurrent headache is a risk factor for subsequent cerebral ischemia in pediatric brain tumor survivors treated with radiation. The investigators distinguish between these neurovascular events and the syndrome of stroke-like migraine after radiation therapy (SMART). SMART is characterized by neurologic deficits that resolve completely after weeks or months, without EEG evidence of seizures, and transient MRI changes of posterior cortical gyral enhancement following cranial irradiation [2; 3]. Longer life expectancy of children with brain tumors increases the prevalence of complications and the importance of close neurologic surveillance.