The Risks associated with treating S.M.A.R.T syndrome using Blood Thinners for pediatric patients who received Cranial/Spinal irradiation. A case study.
DOI:
https://doi.org/10.47611/jsrhs.v12i4.5781Keywords:
S.M.A.R.T Syndrome, Epidural Hematoma, Blood thinners, Aspirin, Vascular dysregulation, cerebral endothelial dysfunction, Case StudyAbstract
S.M.A.R.T Syndrome (Stroke-like Migraine Attacks after Radiation Therapy) is a late complication after cranial radiation, along with seizures, and white matter lesions. SMART syndrome is diagnosed in patients who previously received craniospinal irradiation presenting with unexplained headaches, seizures and hemiparesis (weakness on one side of the body which is revirsable) few years after irradiation. M.R.I (Magnetic resonance imaging) is usually helpful in diagnosis. In such cases, blood thinners such as Aspirin are prescribed as a medication to decrease the potential risks associated with radiation induced brain infarction/necrosis to avoid further deterioration. However blood thinners such as Aspirin have been linked to sudden hematoma occurring in the brain. The case reported was observed in a patient with vasculopathy/S.M.A.R.T syndrome who previously underwent high dose chemotherapy, and craniospinal irradiation (CSI) and was prescribed baby aspirin which may have contributed to epidural hematoma/hemorrhage.
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Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: DF-0613956; 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Patient Viewable Clinical Documentation DOCUMENT NAME: Endocrinology Visit SERVICE DATE/TIME: 5/9/2017 14:02 EDT RESULT STATUS: Auth (Verified)
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: DF-0613956; 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Patient Viewable Clinical Documentation DOCUMENT NAME: Neurology Visit SERVICE DATE/TIME: 6/22/2016 12:35 EDT RESULT STATUS: Auth (Verified)
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: DF-0613956; 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Radiology ACCESSION EXAM DATE/TIME PROCEDURE ORDERING PROVIDER STATUS RA-16-0148294 8/18/2016 11:45 EDT MR-Brain w/+w/o + Angiography w/o Contr . Figure 2, 3, and 4 are cited from these MRI/MRA images.
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: DF-0613956; 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Radiology ACCESSION EXAM DATE/TIME PROCEDURE ORDERING PROVIDER STATUS RA-16-0146675 8/16/2016 12:51 EDT MR-Brain/Vent Check Limited Figure 1 is cited from this MRI/Vent Check image.
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 Age: 6 years Sex: Male THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Procedure Notes ADMIT DATE: 8/05/2016 SERVICE DATE/TIME: 8/06/2016 10:45 EDT DOCUMENT NAME: Operative Note REPORT REQUEST ID: 24452406
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 Age: 6 years Sex: Male THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Procedure Notes ADMIT DATE: 8/05/2016 SERVICE DATE/TIME: 8/06/2016 10:02 EDT DOCUMENT NAME: Operative Note REPORT REQUEST ID: 24452407
Boston Children's Hospital Patient Name: CHIVUKULA, ANIKETH 300 Longwood Avenue MRN: DF-0613956; 465-99-36 Boston, MA 02115 Date of Birth: 6/9/2010 THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD Radiology ACCESSION EXAM DATE/TIMERA-14-0116415 7/16/2014 11:18 EDT
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