technetium-tc-99m-bicisate and Hyperglycemia

A 68-year-old man with diabetes mellitus type 2 presented himself with visual distortion and apraxia. Nonketotic hyperglycemic seizure with both motor and sensory components was suspected. Tc-ECD perfusion SPECT demonstrated hyperperfusion at right parieto-occipital lobe during ictal phase. Normalization of hyperperfused area was noted on follow-up perfusion SPECT after intense glucose control. In nonketotic hyperglycemic state, the depletion of GABA in cerebral neurons lowers the seizure threshold. We demonstrated that ictal phase perfusion SPECT contributed to not only diagnosis but also served as a follow-up tool.

Topics: Aged; Cysteine; Humans; Hyperglycemia; Male; Occipital Lobe; Organotechnetium Compounds; Parietal Lobe; Perfusion Imaging; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

Diabetes mellitus increases the risk of ischemic stroke. The aim of this study was to investigate the correlation between fasting plasma glucose (FPG) and changes in regional cerebral perfusion (CP) in subjects with DM.. CP was assessed in 24 subjects (mean age 44+/-2.5 years) with type 1 diabetes mellitus by single photon emission computed tomography.. Analysis of CP during elevated FPG (224+/-24 mg/dL) showed 3 or more deficits in 42% of the subjects. A positive relationship between the number of CP deficits and FPG was observed (P<0.01), but not with age, sex, body mass index, or duration of diabetes mellitus. Regional deficits were reduced (P<0.001) with improvement in FPG (119+/-5 mg/dL). This reduction remained significant after adjustment for age, sex, and body mass index. Plasma levels of P-selectin, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1, established markers of endothelial dysfunction, were significantly decreased with lower FPG. Furthermore, thiobarbituric acid reactive substance plasma levels, an index of oxidative stress, were also reduced (P<0.01).. The present study demonstrates that changes in FPG are associated with functional changes in regional CP. Hyperglycemia-induced endothelial dysfunction may be implicated in the impaired regional CP of diabetic subjects.

Topics: Adult; Biomarkers; Blood Glucose; Causality; Cerebral Arteries; Cerebrovascular Circulation; Cerebrovascular Disorders; Cysteine; Diabetes Complications; Endothelial Cells; Female; Humans; Hyperglycemia; Intercellular Adhesion Molecule-1; Male; Middle Aged; Organotechnetium Compounds; Oxidative Stress; P-Selectin; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Thiobarbituric Acid Reactive Substances; Tomography, Emission-Computed, Single-Photon; Vascular Cell Adhesion Molecule-1

We described a 61-year-old man with diabetes mellitus who presented with hyperglycemia related paroxysmal kinesigenic dyskinesia (PKD) with sudden development of paroxysmal unilateral involuntary movements (IMs) of his neck and the left extremities. Ictal 99mTc-ethylcysteinate dimer SPECT (ECD-SPECT) revealed a hyperperfusion over the contralateral frontal cortex and a hypoperfusion over the contralateral basal ganglia. Immediate correction of hyperglycemia after admission resulted in a marked improvement of IMs and a return to normal cerebral blood flow on interictal ECD-SPECT imaging. These findings suggest that dysfunction of the indirect pathway through the basal ganglia lead to an imbalance of the cortico-striato-thalamo-cortical circuit and may have contributed to the cause of PKD in this case.

Topics: Basal Ganglia; Cerebrovascular Circulation; Chorea; Cysteine; Diabetes Complications; Electroencephalography; Humans; Hyperglycemia; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

A case of hemichorea in a patient with poorly controlled diabetes is reported. T1-weighted magnetic resonance imaging (MRI) showed an unusual homogeneous high-intensity area in the corpus striatum. Of interest in the case was the fact that the globus pallidus, which was enhanced with gadolinium at the onset of hemichorea, showed homogeneous high-intensity on a subsequent T1-weighted image. This indicated that blood brain barrier destruction preceded the signal intensity change in the basal ganglia. As far as the authors could determine, this is the first reported case showing such enhancement during the course of diabetic hemichorea.

Topics: Anti-Dyskinesia Agents; Basal Ganglia; Blood-Brain Barrier; Chorea; Corpus Striatum; Cysteine; Diabetes Complications; Diabetes Mellitus; Gadolinium DTPA; Globus Pallidus; Haloperidol; Humans; Hyperglycemia; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Radiopharmaceuticals; Tiapamil Hydrochloride; Tomography, Emission-Computed, Single-Photon