technetium-tc-99m-exametazime and Cerebellar-Ataxia

We prospectively evaluated consecutive cases of acute cerebellar ataxia in children to identify brain perfusion SPECT features associated with acute cerebellar ataxia and to correlate the brain SPECT findings to clinical severity and prognosis.. Among the 10 consecutive children with acute cerebellar ataxia, 7 had abnormal Tc-99m HMPAO brain SPECT findings (4 cerebellar hypoperfusion, 5 unilateral cortical and/or subcortical hypoperfusion, and 1 unilateral cortical hyperperfusion), in contrast to no abnormalities disclosed by CT or MR imagings. Furthermore, the extent of brain perfusion SPECT abnormalities correlated significantly with the clinical severity and the recovery time of cerebellar ataxia. Sixty percent of children with acute cerebellar ataxia had cortical and/or subcortical involvement, which implied the wider involvement of acute cerebellar ataxia than what has been thought.. The present data suggest that Tc-99m HMPAO brain SPECT is a sensitive modality for providing prognostic information in childhood acute cerebellar ataxia.

Topics: Brain; Cerebellar Ataxia; Child; Female; Follow-Up Studies; Humans; Male; Perfusion; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A 19 year-old man presented with pharyngitis and cervical lymphadenopathy, followed by vomiting and acute cerebellar ataxia. Serologic studies were consistent with a recent Epstein-Barr virus infection. Although contrast-enhanced brain computed tomography and MRI scans were normal, brain perfusion single photon emission tomography (SPECT) examination using 99mTc-HMPAO, performed on the 15th day of illness, showed marked cerebellar hyperperfusion, suggesting a diagnosis of acute post-infectious cerebellitis. After treatment with intravenous human immunoglobulin (IVIg, 2 g kg-1 over three days), progressive neurologic improvement occurred over two weeks. A brain SPECT study repeated after two additional weeks demonstrated a normal perfusion pattern. We conclude that brain perfusion SPECT examination is useful in identifying post-infectious cerebellitis and in monitoring its clinical course. In addition, IVIg may be helpful in treating this condition.

Topics: Adult; Cerebellar Ataxia; Cerebrovascular Circulation; Encephalitis, Viral; Herpesvirus 4, Human; Humans; Immunoglobulins, Intravenous; Magnetic Resonance Imaging; Male; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon