technetium-tc-99m-exametazime and Hallucinations

Psychotic symptoms are produced by distributed neuronal dysfunction. Abnormalities of reality testing and false inference implicate frontal lobe abnormalities.. To identify the functional imaging profile of patients with Alzheimer's disease manifesting psychotic symptoms as measured by single photon emission computed tomography (SPECT).. Twenty patients with Alzheimer's disease who had SPECT and clinical evaluations were divided into two equal groups with similar mini mental status examination (MMSE), age, sex, and the range of behaviours documented by the neuropsychiatric inventory (NPI), except delusions and hallucinations. SPECT studies, registered to a probabilistic anatomical atlas, were normalised across the combined group mean intensity level, and subjected to a voxel by voxel subtraction of the non-psychotic minus psychotic groups. Subvolume thresholding (SVT) corrected random lobar noise to produce a three dimensional functional significance map.. The significance map showed lower regional perfusion in the right and left dorsolateral frontal, left anterior cingulate, and left ventral striatal regions along with the left pulvinar and dorsolateral parietal cortex, in the psychotic versus non-psychotic group.. Patients with Alzheimer's disease who manifest psychosis may have disproportionate dysfunction of frontal lobes and related subcortical and parietal structures.

Topics: Alzheimer Disease; Brain Mapping; Cerebrovascular Circulation; Corpus Striatum; Delusions; Female; Frontal Lobe; Gyrus Cinguli; Hallucinations; Humans; Male; Parietal Lobe; Psychotic Disorders; Sex Factors; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A 55-year-old woman was diagnosed with the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). She was referred for Tc-HMPAO brain SPECT because of visual hallucinations, which were suspected to be related to epileptic seizures. Ictal SPECT images showed remarkable hyperperfusion in the left occipital cortex, which returned to near-normal status on the interictal SPECT images after treatment with anticonvulsants. It is very rare to see such an ictal SPECT image of epileptic or epilepsy-like disorders, especially in the setting of MELAS syndrome with visual hallucination.

Topics: Brain; Epilepsy; Female; Hallucinations; Humans; MELAS Syndrome; Middle Aged; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Hyperglycemia may rarely be seen with visual seizures. Observation of both visual evoked potentials (VEPs) and magnetic resonance imaging (MRI) in visual status epilepticus (SE) has not been reported. We describe acute and follow-up VEP and MRI findings of a patient with hyperglycemia-related visual SE of occipital origin.. In a 59-year-old diabetic woman, complex visual hallucinations and illusions developed with < or =10 seizures per hour as an initial manifestation of nonketotic hyperglycemia.. Neurologic examination revealed ictal nystagmus to the right and continuous right hemianopsia. Ictal electroencephalography (EEG) and Tc-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission computed tomography (SPECT) revealed an epileptogenic focus in the left occipital lobe. MRI with fluid-attenuated inversion recovery showed focal subcortical hypointensity and gyral hyperintensity. Follow-up MRI showed only minimal gyral hyperintensity at 6 months. The P100 amplitude of VEP was significantly higher at the right occipital area during SE, but slightly higher on the left after the patient had been seizure free for 6 months.. Occipital seizures and hemianopsia can be caused by hyperglycemia and may be accompanied by special MRI and VEP findings.

Topics: Electroencephalography; Epilepsy; Evoked Potentials, Visual; Female; Functional Laterality; Hallucinations; Hemianopsia; Humans; Hyperglycemia; Illusions; Magnetic Resonance Imaging; Middle Aged; Occipital Lobe; Status Epilepticus; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Body Image; Brain; Child; Female; Hallucinations; Humans; Illusions; Perceptual Disorders; Radiopharmaceuticals; Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Episodic nocturnal wandering is rare and thought to be an atypical form of nocturnal epilepsy which is responsive to anticonvulsant therapy. We report a case of adult-onset episodic sleep-walking and daytime complex visual hallucination. Ambulatory EEG recordings suggested that both events were ictal phenomenon. Interictal sphenoidal EEG and SPECT studies revealed an epileptogenic focus in the left anterior temporal lobe. During the nocturnal wanderings, the patient had bizarre but non-violent behaviour, and was at risk of minor or severe injury to himself. Both events were completely controlled by carbamazepine for a follow-up period of 8 years. The present case further supports the notion that episodic nocturnal wandering represents an unusual type of nocturnal complex partial seizures.

Topics: Adult; Cerebral Cortex; Diagnosis, Differential; Dominance, Cerebral; Electroencephalography; Epilepsy, Temporal Lobe; Follow-Up Studies; Hallucinations; Humans; Male; Monitoring, Physiologic; Somnambulism; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Visual Perception

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

This study examined whether psychosis in Alzheimer's disease is associated with cerebral perfusion patterns appreciable by single photon emission computed tomography (SPECT) scans.. All cooperative outpatients enrolled in an Alzheimer's disease research center with the diagnosis of probable Alzheimer's disease and a Clinical Dementia Rating of mild or moderate were interviewed with their primary caregivers. Current and past psychiatric functioning was assessed by using the Hamilton Depression Rating Scale, the Structured Clinical Interview for DSM-III-R, and the Behavioral Pathology in Alzheimer's Disease Rating Scale. Patients without premorbid psychosis received SPECT scans, and the scans of the patients with delusions or hallucinations (N = 30) were compared to the scans of patients without these symptoms (N = 16).. The patients with delusions (N = 29) had hypoperfusion of the left frontal lobe in relation to the right frontal lobe. The patients with hallucinations (N = 10) had hypoperfusion in the parietal lobe.. Psychotic patients with Alzheimer's disease had a pattern of cerebral blood flow deficits significantly different from that of nonpsychotic patients. This suggests that patterns of cerebral dysfunction may be expressed symptomatically as psychosis.

Topics: Alzheimer Disease; Ambulatory Care; Brain; Cerebrovascular Circulation; Comorbidity; Delusions; Frontal Lobe; Hallucinations; Humans; Organotechnetium Compounds; Oximes; Parietal Lobe; Psychiatric Status Rating Scales; Psychotic Disorders; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Single photon emission tomography with split-dose technetium-99m-d, l-hexamethyl-propylene amine oxime was used to measure regional cerebral blood flow (rCBF) during a memory-activation paradigm in a group of 18 medicated DSM-III-R schizophrenic patients. The relationship between clinical features of schizophrenia and rCBF patterns was examined. Increased blood flow to the left basal ganglia was revealed during activation in patients reporting hallucinations in the previous month, a finding that was not influenced by medication dose or other confounding variables. This result adds to previous functional imaging studies that have related basal ganglia abnormalities to hallucinatory phenomena and suggests that left basal ganglia hyperactivity may be relevant to an internal monitoring deficit responsible for the appearance of those symptoms in schizophrenia.

Topics: Adult; Arousal; Attention; Auditory Perception; Basal Ganglia; Blood Flow Velocity; Brain; Dominance, Cerebral; Female; Hallucinations; Humans; Male; Mental Recall; Middle Aged; Neurocognitive Disorders; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Regional Blood Flow; Schizophrenia; Schizophrenic Psychology; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Verbal Learning

A patient developed visual hallucinations following a left-sided cerebrovascular accident (CVA). Brain SPECT using Tc-99m HMPAO demonstrated increased perfusion at the biparieto-occipital lobes. Following antiepileptic medication, repeat brain SPECT showed interval decrease in perfusion in the same areas with the symptomatic relief of hallucinatory episode. While it is possible that the interval decrease is due to natural resolution, the authors believe that it is likely due to drug treatment.

Topics: Aged; Anticonvulsants; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Female; Hallucinations; Humans; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The authors studied a group of thirteen schizophrenic patients with functional brain imaging, using single-photon-emission-computed tomography (S.P.E.C.T.). The radiotracer was the H.M.P.A.O. labelled with 99 m Technetium. All were being given neuroleptic drug. Forty-one lesions demonstrated decreased perfusion. These functional abnormalities are mainly located in the left hemisphere and this asymmetry is more pronounced in positive-symptom schizophrenics. However, at rest, these correlations are limited and finally we demonstrated a wide spectrum of metabolic dysfunctions in the same subtype of schizophrenia.

Topics: Adult; Brain Mapping; Cerebral Cortex; Delusions; Dominance, Cerebral; Energy Metabolism; Female; Hallucinations; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Psychiatric Status Rating Scales; Radionuclide Imaging; Regional Blood Flow; Schizophrenia; Schizophrenic Psychology; Technetium Tc 99m Exametazime

Proceeding from the hypothesis that auditory hallucinations in psychotic patients have another biological basis than hallucinations provoked by hypnotic suggestion in healthy persons, we performed a symptom-comparative study by means of 99mTc-HMPAO single photon emission computed tomography. The results confirm the importance of pathogenesis in symptom-oriented psychiatric research.

Topics: Adult; Auditory Perception; Brain; Dominance, Cerebral; Female; Frontal Lobe; Hallucinations; Humans; Hypnosis; Male; Middle Aged; Organotechnetium Compounds; Oximes; Psychotic Disorders; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

In a symptom-oriented study 17 patients suffering from chronic auditory hallucinations were investigated by means of 99mTc-HMPAO-SPECT and compared with healthy controls. The results confirm the relative frontal hypoactivity in junction with a relative hyperactivity in the basal ganglia and mesial limbic structures in both hemispheres found in a previous pilot study in auditorily hallucinating patients. Our results should fortify the symptom-oriented approach in psychiatric research.

Topics: Adult; Auditory Perception; Basal Ganglia; Brain; Brain Mapping; Dominance, Cerebral; Female; Frontal Lobe; Hallucinations; Hippocampus; Humans; Male; Middle Aged; Organometallic Compounds; Oximes; Psychotic Disorders; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed