technetium-tc-99m-bicisate and Cerebellar-Diseases

Posterior fossa syndrome (PFS) due to vascular etiology is rare in children and adults. To the best of our knowledge, PFS due to cerebellar stroke has only been reported in patients who also underwent surgical treatment of the underlying vascular cause. We report longitudinal clinical, neurocognitive and neuroradiological findings in a 71-year-old right-handed patient who developed PFS following a right cerebellar haemorrhage that was not surgically evacuated. During follow-up, functional neuroimaging was conducted by means of quantified Tc-99m-ECD SPECT studies. After a 10-day period of akinetic mutism, the clinical picture developed into cerebellar cognitive affective syndrome (CCAS) with reversion to a previously learnt accent, consistent with neurogenic foreign accent syndrome (FAS). No psychometric evidence for dementia was found. Quantified Tc-99m-ECD SPECT studies consistently disclosed perfusional deficits in the anatomoclinically suspected but structurally intact bilateral prefrontal brain regions. Since no surgical treatment of the cerebellar haematoma was performed, this case report is presumably the first description of pure, "non-surgical vascular PFS". In addition, reversion to a previously learnt accent which represents a subtype of FAS has never been reported after cerebellar damage. The combination of this unique constellation of poststroke neurobehavioural changes reflected on SPECT shows that the cerebellum is crucially implicated in the modulation of neurocognitive and affective processes. A decrease of excitatory impulses from the lesioned cerebellum to the structurally intact supratentorial network subserving cognitive, behavioural and affective processes constitutes the likely pathophysiological mechanism underlying PFS and CCAS in this patient.

Topics: Aged; Cerebellar Diseases; Cranial Fossa, Posterior; Cysteine; Follow-Up Studies; Humans; Male; Mutism; Neuropsychological Tests; Organotechnetium Compounds; Stroke; Tomography, Emission-Computed, Single-Photon

In the recent literature there is no consensus regarding the relationships between crossed cerebellar diaschisis (CCD) with the primary lesion size, severity or location. Thus, the aim of the present study was to investigate relationship between the size and severity of cerebral lesions and CCD in patients with chronic stroke, using voxel-based analysis of Tc-99m ECD single-photon emission computed tomography (SPECT).. We retrospectively reviewed data of 57 patients with chronic ischemic lesions localized unilaterally in the cerebral hemisphere. SPECT evaluation was performed with the voxel-based analysis. The percentage inter-hemispheric asymmetry index (AI) and the volume of abnormal clusters of voxels (CV) were ascertained for hypoperfusion in the supratentorial lesion and contralateral cerebellum.. CCD was present in 35.1% cases. In Group CCD (+), the CV and AI of supratentorial hypoperfusion (median 128.1 ml and 21.9%, respectively) were significantly higher compared with Group CCD(-) (median 41.4 ml and 18.0%, respectively). Statistically significant correlation was found between CV of supratentorial and cerebellar perfusion defects (r = 0.4; p < 0.05), between AI of supratentorial and cerebellar perfusion defects (r = 0.6; p < 0.05) and between CV of supratentorial defect and AI of cerebellar perfusion defects (r = 0.6; p < 0.05).. Our data suggest, that in the chronic stage of stroke, the size and severity of the supratentorial lesion are determinants of CCD, correlating with the degree of cerebellar hypoperfusion.

Topics: Adult; Aged; Aged, 80 and over; Brain; Cerebellar Diseases; Cysteine; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organotechnetium Compounds; Retrospective Studies; Tomography, Emission-Computed, Single-Photon

The posterior fossa syndrome (PFS) consists of transient cerebellar mutism, cognitive symptoms and neurobehavioural abnormalities that typically develop in children following posterior fossa tumour resection. Although PFS has been documented in more than 350 paediatric cases, reports of adult patients with a vascular aetiology are extremely rare. In addition, the pathophysiological substrate of the syndrome remains unclear. We report an adult patient with PFS after surgical evacuation of a cerebellar bleeding. After 45 days of (akinetic) mutism, the patient's cognitive and behavioural profile closely resembled the "cerebellar cognitive-affective syndrome". A quantified SPECT study showed perfusional deficits in the anatomoclinically suspected supratentorial areas, subserving language dynamics, executive functioning, spatial cognition and affective regulation. We hypothesize that cerebello-cerebral diaschisis might be an important pathophysiological mechanism underlying akinetic mutism, cognitive deficits and behavioural-affective changes in adult patients with PFS.

Topics: Cerebellar Diseases; Cerebral Hemorrhage; Cranial Fossa, Posterior; Cysteine; Humans; Intelligence; Male; Middle Aged; Mutism; Neuropsychological Tests; Organotechnetium Compounds; Postoperative Complications; Radiopharmaceuticals; Speech Disorders; Stroke; Tomography, Emission-Computed, Single-Photon; Verbal Behavior; Wechsler Scales

Bilateral symmetric striopallidodentate calcinosis, also known as Fahr's disease, is characterized by bilateral calcifications of the basal ganglia, thalami, dentate nuclei of the cerebellum, and the white matter of the cerebral hemisphere. Intracranial calcifications are easily visible as high-density areas on computed tomographic images. On magnetic resonance images, the calcifications exhibit different signal intensities. The differences in signal intensity are thought to be related to the stage of the disease, differences in calcium metabolism, and the volume of the calcium deposit. The moderate reduction of cerebral blood flow in bilateral thalami was also identified using brain SPECT.

Topics: Aged; Basal Ganglia Diseases; Brain Diseases; Calcinosis; Cerebellar Diseases; Cysteine; Dysarthria; Gait Ataxia; Humans; Male; Occipital Lobe; Organotechnetium Compounds; Paralysis; Radiography; Radiopharmaceuticals; Thalamic Diseases; Tomography, Emission-Computed, Single-Photon

The purpose of our study was to evaluate the remote effects on the cerebellum and cerebral cortex from subcortical hematoma without cortical structural abnormality.. Our study included 23 patients with hematoma, strictly confined either to the basal ganglia (n = 12) or thalamus (n = 11) without cortical abnormality on CT or MRI. Twenty psychiatric patients without structural abnormality on MRI were selected as control subjects. Technetium-ethyl cysteinate dimer brain SPECT was performed in patients and control subjects. Regional cerebral blood flow (rCBF) was visually and semiquantitatively assessed. Asymmetry index (AI) was determined using data from regions of interest at the basal ganglia, thalamus, cerebellum, frontal, parietal and temporal cortex to support the semiquantitative analysis. The criteria for defining hypoperfusion that reflected diaschisis was based on an AI > the mean + 2 s.d. of AI in control subjects.. In the basal ganglia hematoma, rCBF was reduced significantly in the contralateral cerebellum (10/12), ipsilateral thalamus (12/12), ipsilateral frontal (6/12), parietal (12/12) and temporal cortex (10/12). As for thalamic hematoma, significantly reduced perfusion was seen in the contralateral cerebellum (10/11), ipsilateral basal ganglia (7/11), ipsilateral frontal (5/11), parietal (11/ 11) and temporal cortex (3/11).. Crossed cerebellar diaschisis (CCD) and cortical diaschisis frequently were observed in patients with subcortical hematoma without cortical structural abnormality. This suggested that CCD can develop regardless of interruption of the corticopontocerebellar tract, which is the principal pathway of CCD.

Topics: Adult; Aged; Basal Ganglia Diseases; Brain; Cerebellar Diseases; Cerebral Hemorrhage; Cerebrovascular Circulation; Cysteine; Female; Functional Laterality; Humans; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Regional Blood Flow; Thalamic Diseases; Tomography, Emission-Computed, Single-Photon