technetium-tc-99m-exametazime and Hematoma--Subdural

Left-sided hemichorea developed suddenly in a 73-year-old male. Computed tomography revealed a left subdural hematoma (SDH) and infarction in the right corona radiata and temporo-occipital region. Hemichorea subsided completely after removal of the SDH. Postoperative single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime revealed a global low-perfusion area in the right cerebral hemisphere. Right carotid angiography demonstrated severe stenosis of the trunk of the right middle cerebral artery. The cerebral blood flow in the right cerebral hemisphere had probably already decreased to nearly the critical level and was reduced further by the left SDH, inducing the left-sided hemichorea due to dysfunction of the right cerebral hemisphere. This case shows that when hemichorea ipsilateral to a SDH is present, it is important to ascertain whether there is a pre-existing ischemic lesion in the contralateral cerebral hemisphere, particularly in the basal ganglia, thalamus, or corona radiata.

Topics: Aged; Cerebral Infarction; Chorea; Chronic Disease; Dominance, Cerebral; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Accidents, Traffic; Adult; Brain Death; Brain Injuries; Cerebrovascular Circulation; Hematoma, Subdural; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

Cerebral blood flow (CBF) measured by 99mTc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the hemiparesis group. And such disturbance was finally observed as the CBF reductions in whole brain in the consciousness disturbance group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cerebellum; Cerebrovascular Circulation; Chronic Disease; Consciousness Disorders; Female; Headache; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Putamen; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Exametazime; Thalamus; Tomography, Emission-Computed, Single-Photon

Cerebral blood flow(CBF) in 34 patients with bilateral chronic subdural hematoma was measured by 99mTc-HMPAO SPECT before operation. The regional CBF was measured in 26 regions of the 10 cortical regions, putamen, thalamus and cerebellar hemisphere on both sides. According to the thickness of subdural hematoma, the thicker hematoma side was measured and examined as the thick hematoma side, and the other side as the thin hematoma side. Thirty four cases with bilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 13 cases with headache(headache group), 10 cases with hemiparesis(hemiparesis group), 5 cases with tetraparesis(tetraparesis group) and 6 cases with consciousness disturbance or dementia(consciousness disturbance group), and into two groups according to the degree of midline brain shift on MRI: 14 cases of non-shifted group and 20 cases of shifted group. The average CBF of 34 patients in each region indicated a regional CBF reduction in the frontal, parietal and occipital cortices on the thin hematoma side, and in the putamen on the thick hematoma side. In the headache group, the regional CBF reduction on the thin hematoma side was found in the frontal, parietal and occipital cortices compared with the corresponding regions on the thick hematoma side, and in thalamus on the thick hematoma side. In the hemiparesis and tetraparesis groups, there was no statistically significant CBF reduction between the thick and thin hematoma sides. In the consciousness disturbance group, the CBF reduction in whole brain was remarkably significant. By the degree of the midline brain shift, the CBF reductions between the thick and thin hematoma sides were observed. Namely, in the shifted group, the CBF reductions were noted in the frontal, parietal and occipital cortices in the thin hematoma side, and in the putamen in the thick hematoma side. We concluded that the CBF reduction of bilateral chronic subdural hematoma was bilaterally found in the hemiparesis and tetraparesis groups, and which was finally observed in whole brain in the consciousness disturbance group.

Topics: Adult; Aged; Aged, 80 and over; Blood Volume; Cerebral Cortex; Cerebrovascular Circulation; Chronic Disease; Consciousness Disorders; Female; Headache; Hematoma, Subdural; Hemiplegia; Humans; Male; Middle Aged; Quadriplegia; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Exametazime

We report the relationship between cerebral blood flow (CBF) and neuropsychologic tests in a patient with a chronic subdural hematoma suffering from severe dementia and left hemiparesis. Regional CBF was quantified using 99mTc-HMPAO SPECT and 133Xe-CBF. CBF-SPECT could detect the hematoma which was isodense by CT scan and the neuropsychological test improved remarkably with the increase in CBF after surgery. We conclude that if there is a strong clinical suspicion of subdural hematoma and CT scan is not diagnostic then CBF-SPECT may be valuable in localizing the hematoma and monitoring the effect of operation.

Topics: Aged; Cerebrovascular Circulation; Chronic Disease; Hematoma, Subdural; Humans; Male; Neuropsychological Tests; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The cerebral distribution of HMPAO was mapped tomographically by SPECT in 20 patients with an intra cerebral haematoma. The images were assessed visually and by an analysis of an asymmetry index (AI) for various cerebral areas. Visual inspection identified the lesion in each of the 20 cases. Reduced tracer activity and abnormal AI were consistent findings. Remote effects (diaschisis) were also observed in the adjacent (19 cases) and frontal (14 cases) cortex, and in the controlateral cerebellum (16 cases). Sequential studies at 60, 150 and 300 minutes in 10 patients showed remarkably stable patterns. HMPAO maps were compared with cerebral blood flow (CBF) measured with 133 Xenon (133Xe) in eight cases. The two methods showed similar results in the region of a lesion, but remote effects were more obvious with the 133Xe in two patients.

Topics: Adult; Aged; Brain; Brain Mapping; Cerebrovascular Circulation; Female; Hematoma, Subdural; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Xenon Radioisotopes

An elderly patient with a complex history of organic dementia but a normal neurologic examination had a 99mTc-hexamethylpropylene-amine-oxime (HMPAO) brain scan for a suspected cerebrovascular accident or space-occupying lesion. The study showed no perfusion abnormality in the brain parenchyma, but bilateral flattening and inversion of the normal hemispheric convexities, with separation from the skull was identified. Bilateral subdural hematomas (SDH) were suspected and the patient had a computed tomographic scan that confirmed the diagnosis.

Topics: Aged; Brain; Hematoma, Subdural; Humans; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed