technetium-tc-99m-exametazime and Epilepsia-Partialis-Continua

Topics: Brain Mapping; Electroencephalography; Epilepsia Partialis Continua; Functional Laterality; Humans; Hyperglycemia; Male; Middle Aged; Parietal Lobe; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The authors report a 61-year-old man with chronic viral encephalitis and Koshevnikov syndrome occurring 42 months after initial symptom of right hemiparesis. Serial computed tomography of the brain showed changes in the attenuation of the left temporal lobe lesion over time. Magnetic resonance images of the brain showed enlargement of left temporoparietooccipital lobes with cortical gyral enhancement on T1-weighted images following intravenous administration of gadolinium-DTPA. 99mTc-HMPAO single-photon emission computerized tomography showed increased radioactivity and hyperperfusion in the left temporoparietal region with paradoxically decreased local tissue perfusion at the contralateral right hemisphere. Follow-up magnetic resonance images of the brain 4 years later showed atrophy of bilateral cerebral hemispheres. We postulate that a "transcallosal diaschisis" with subsequent degeneration is a possible mechanism. A brain biopsy from the left temporal lobe lesion showed pictures compatible with viral encephalitis probably herpes simplex encephalitis.

Topics: Atrophy; Brain; Brain Diseases; Cerebrovascular Circulation; Chronic Disease; Contrast Media; Corpus Callosum; Encephalitis, Viral; Epilepsia Partialis Continua; Follow-Up Studies; Gadolinium DTPA; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; DNA, Mitochondrial; Electroencephalography; Epilepsia Partialis Continua; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; MELAS Syndrome; Point Mutation; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A three-year-old girl with epilepsia partialis continua involving the left side of the face and the left arm and leg was followed-up by 99mTc-HMPAO-SPECT in addition to EEG and CT. Increased regional cerebral blood flow was found in the right Rolandic area in the early stage of the disease, when the CT was normal and the EEG showed marked right hemispheric slowing. Seven months later severe hypoperfusion, extending to the right fronto-temporal region, and localised hyperperfusion in the right parietal area were observed by the 99mTc-HMPAO-SPECT when CT detected right hemispheric atrophy and EEG recorded severe epileptic activity, involving even the contralateral areas. The 99mTc-HMPAO-SPECT proved to be useful for the follow-up of the dynamics of the disease process.

Topics: Cerebrovascular Circulation; Child, Preschool; Electroencephalography; Epilepsia Partialis Continua; Female; Follow-Up Studies; Humans; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed