technetium-tc-99m-exametazime and Conjunctival-Diseases

Two patients with SUNCT syndrome (short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing) were investigated. Blood flow velocity in the middle cerebral artery was monitored before, during, and outside four spontaneous attacks. An interhemispheric asymmetry was observed. In the second case, velocity decreased significantly on both sides during attacks in comparison with preattack values. Cerebral SPECT (single photon emission computed tomography) images were obtained during a bout and between attacks in one patient. The radiocompound was injected 5 to 10 seconds after the start of an attack. In both patients, normal tracer uptake and symmetric perfusion was observed during headache periods.

Topics: Aged; Blood Flow Velocity; Brain; Cerebrovascular Circulation; Cluster Headache; Conjunctival Diseases; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The pathogenesis of neurologic and neuropsychologic dysfunction in HIV-1 infection is unclear. The purpose of the study was to determine an association between cerebral perfusion and HIV-1-related ocular microangiopathic syndrome.. We studied 28 HIV-1-infected patients, seven of whom presented with asymptomatic HIV infection, nine with lymphadenopathy syndrome or AIDS-related complex, and 12 with AIDS. Cerebral perfusion was semi-quantitatively measured by single photon emission computed tomography of the brain using technetium-99 hexamethyl-propylenamine oxime (HMPAO-SPECT). The conjunctival manifestation of HIV-1-related microangiopathic syndrome was measured by a rating scale determining blood-flow sludging and, retinal cotton-wool spots were counted. CD4 count, neopterin, beta 2-microglobulin (beta 2M), haemoglobin, and age were determined as putative confounding variables.. Mean conjunctival sludge in patients with normal HMPAO-SPECT findings was 1.3 +/- 0.5 (mean +/- s.e.m.); no cotton-wool spots were present. In patients with slightly impaired HMPAO-SPECT, it was 2.1 +/- 0.6 and mean cotton-wool spot count was 1.1 +/- 0.4. In patients with severely impaired HMPAO-SPECT, mean conjunctival sludge was 4.5 +/- 0.3 and mean cotton-wool spot count was 4.9 +/- 1.1 HMPAO-SPECT findings were closely associated with conjunctival sludge (r = 0.72; P < 0.001) and number of cotton-wool spots (r = 0.78; P < 0.001), whereas only a slight association with staging of HIV disease was found (P = 0.052). Analysis of covariance controlling for CD4 count neopterin, beta 2M, age, and haemoglobin demonstrated a significant difference between the three HMPAO-SPECT groups for both the number of cotton-wool spots (P < 0.001) and the conjunctival sludge rating (P < 0.001).. There was a close association between severity of HIV-1-related ocular microangiopathic syndrome and severity of cerebral hypoperfusion. Microvascular alterations might contribute to the pathogenesis of neurological and neuropsychological symptoms in patients with HIV-1 disease. Furthermore, the conjunctival sludge rating and the number of cotton-wool spots might be appropriate indicators for severity of microvascular changes of the central nervous system [corrected].

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; AIDS-Related Complex; beta 2-Microglobulin; Biopterins; Brain; CD4-Positive T-Lymphocytes; Conjunctiva; Conjunctival Diseases; Hemoglobins; HIV Infections; HIV-1; Humans; Leukocyte Count; Male; Microcirculation; Middle Aged; Neopterin; Organotechnetium Compounds; Oximes; Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon