Successful identification and management of a stroke-like migraine attacks after radiation therapy syndrome occurring 36 years after cranial irradiation.

Stroke-like migraine attacks after radiation therapy syndrome is a rare, late-onset neurological disorder observed in patients with a history of cranial radiation therapy. It presents with stroke-like symptoms, including hemiparesis, hemianopsia, seizures, and migraines, often occurring years or decades post-therapy. We report a case of stroke-like migraine attacks after radiation therapy syndrome in a 51-year-old male, manifesting 36 years after treatment for oligodendroglioma with whole-brain irradiation. The patient developed sudden worsening of left hemiparesis, focal seizures, and bilateral frontotemporal headaches. Brain MRI revealed hyperintensity on T2 fluid-attenuated inversion recovery sequence and gyral enhancement in the right parieto-occipital cortex. The patient responded favourably to a 5-day course of steroid pulse therapy (1000mg/day), with significant clinical improvement and resolution of MRI abnormalities. This case highlights one of the longest documented latencies for stroke-like migraine attacks after radiation therapy syndrome and emphasizes the importance of considering this diagnosis in patients after irradiation, even after extended latency periods, to prevent misdiagnosis and inappropriate treatment.