technetium-tc-99m-exametazime and Epstein-Barr-Virus-Infections

We used Technetium-99m hexamethyl propylene amine oxime single-photon emission computed tomography (HMPAO-SPECT) and magnetic resonance imaging (MRI) to evaluate a 30-year-old woman who developed cerebellar dysfunction after infection with Epstein Barr virus. Although no abnormal findings were evident from a brain MRI, the HMPAO-SPECT revealed increased perfusion in both cerebellar hemispheres. The patient improved without specific treatment. Two sequential HMPAO-SPECTs showed gradually reduced hyperperfusion in the cerebellum, which was correlated with her clinical recovery. We suggest that brain HMPAO-SPECT may thus be useful for identifying acute cerebellitis and predicting its clinical outcome.

Topics: Adult; Cerebellar Diseases; Cerebellum; Cerebral Cortex; Dominance, Cerebral; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Follow-Up Studies; Gait Ataxia; Humans; Hyperemia; Image Enhancement; Image Processing, Computer-Assisted; Neurologic Examination; Regional Blood Flow; Remission, Spontaneous; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Alice in Wonderland syndrome (AIWS) is characterized by visual hallucinations and bizarre perceptual distortions. Technetium-99m hexamethylpropyleneamine tomography (SPECT) brain scans were performed in four patients during the acute stage of AIWS. Two patients were demonstrated to have Epstein-Barr virus infections. One had abnormal (EEG) findings. The visual-evoked potential, cranial CT, and MRI findings were negative. The decreased cerebral perfusion areas in all patients were near the visual tract and visual cortex. All involved some regions of the temporal lobe. In most patients with AIWS, the EEG, CT, and MRI are unable to determine the precise pathologic areas. However, a SPECT brain scan may demonstrate abnormal perfusion areas and explain the clinical presentations.

Topics: Cerebrovascular Circulation; Electroencephalography; Epstein-Barr Virus Infections; Female; Hallucinations; Humans; Infant; Male; Perceptual Disorders; Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Visual Cortex; Visual Pathways