technetium-tc-99m-exametazime and Hemiplegia

Alternating hemiplegia of childhood (AHC) is a rare and intractable disorder of unknown cause. To determine cerebral neuronal function in five patients with AHC (two adults and three children), we analyzed brain glucose metabolism by positron emission tomography (PET) using 2-deoxy-2 [(18)F] fluoro-d-glucose (FDG), performed between hemiplegic attacks. Interictal FDG-PET revealed abnormal cerebral glucose metabolism; all patients showed low glucose metabolism in the frontal lobes with some laterality, and three had low glucose metabolism in the ipsilateral putamen. The adult patients also showed low glucose metabolism and mild atrophy in the cerebellum. Glucose metabolism in the brainstem was virtually normal for all patients. The areas of low glucose metabolism indicated local or regional neuronal damage, possible reflecting progressive neurological symptoms. AHC might therefore result from focal abnormal glucose metabolism in the brain occurring progressively or permanently, particularly in the frontal lobes and the cerebellum.

Topics: Adult; Brain; Carbon Radioisotopes; Cerebellum; Cerebrovascular Circulation; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Frontal Lobe; Functional Laterality; Glucose; Hemiplegia; Humans; Image Processing, Computer-Assisted; Infant; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Putamen; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Young Adult

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

Topics: Basal Ganglia; Brain; Cerebrovascular Circulation; Epilepsy; Female; Hemiplegia; Humans; Infant; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Thalamus; Tomography, Emission-Computed, Single-Photon

Pseudomigraine with pleocytosis is a benign and autolimited syndrome. The etiology has been related to viral infection, but its pathophysiology is not yet well identified. To investigate this point, and to see if there were changes in cerebral blood flow (as in migraine), we performed single photon emission computed tomography (SPECT) studies in four patients who fulfilled the diagnostic criteria for this syndrome. This was done during the acute phase and we repeated SPECT after resolution of the syndrome in two of them. We found a reduction in brain blood flow on the side of origin of the neurological deficits during the acute phase. This normalized after recovery of the syndrome. The finding suggests that the neurological deficits in this syndrome could be produced by a spreading depression-like mechanism similar to that proposed for migraine with aura.

Topics: Adult; Aphasia; Cerebrovascular Circulation; Cortical Spreading Depression; Female; Headache; Hemiplegia; Humans; Leukocytosis; Male; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Virus Diseases

Single photon emission computed tomography (SPECT) using [123I]iomazenil (radioligand of central-type benzodiazepine receptors) was employed to examine two patients with striatocapsular infarction. Patient 1 was a 61-year-old female with motor aphasia and hemiplegia on the right side. Magnetic resonance imaging (MRI) showed a lesion in the anterior limb of internal capsule and putamen on the left side. SPECT using 99mTc-HMPAO revealed a reduction of cerebral blood flow (CBF) in the frontoparietal region on the left side, but the delayed images in SPECT using [123I]iomazenil showed only a mild decrease of accumulation in the frontal lobe. Patient 2 was a 55-year-old male with hemiplegia on the left side. MRI showed a lesion localized in the basal ganglia and posterior limb of the internal capsule on the right side. SPECT using 99mTc-HMPAO revealed a reduction of CBF in the frontoparietal region on the right side and in the cerebellar hemisphere on the left side, but the delayed images in SPECT using [123I]iomazenil showed little decrease of accumulation in parietal lobe. The discrepancy between CBF and receptor images suggested that cortical hypoperfusion on striatocapsular infarction might reflect hypometabolism due to disconnection of the neuronal network between subcortical structure and cortex.

Topics: Aphasia; Basal Ganglia; Cerebral Cortex; Cerebral Infarction; Cerebrovascular Circulation; Female; Flumazenil; Hemiplegia; Humans; Iodine Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Neostriatum; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

With recent descriptions of the modified hemispherectomies and hemicorticectomy, there has been renewed interest in hemispherectomy for treatment of intractable seizures with hemiparesis. Because long-term outcome remains uncertain, patient selection remains difficult. 99mTc-HmPAO brain SPECT has been a helpful adjunct in the evaluation of epilepsy surgery candidates. We report SPECT scan findings in 7 patients who underwent hemispherectomy and compare these results with scalp EEG findings. Six patients had unilateral SPECT findings and all had a favorable outcome, regardless of surface EEG findings.

Topics: Adolescent; Cerebral Cortex; Cerebral Decortication; Child; Child, Preschool; Dominance, Cerebral; Electroencephalography; Epilepsy; Female; Follow-Up Studies; Hemiplegia; Humans; Infant; Male; Monitoring, Physiologic; Organotechnetium Compounds; Oximes; Postoperative Complications; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Sequential examinations of single photon emission computed tomography (SPECT) were performed on a 5-month-old boy with acute infantile hemiplegia from the acute ictal stage. SPECT was performed with technetium-99m-hexamethyl-propylene-amineoxime during the status when the patient had left-hemiconvulsions (status epilepticus) and on the 3rd, 7th and 10th day after the status. During the ictal stage and the 3rd day after the status, diffuse hyperperfusion was revealed in the right hemisphere, while diffuse hypoperfusion was exhibited in the right hemisphere on the 7th and 10th day after the status. Hypoperfusion in the corresponding hemisphere, after the status, has been reported in patients with acute infantile hemiplegia. There has, however, been no report of ictal brain perfusion. The pathogenesis of this hyperperfusion is not clear, but alteration of brain perfusion in this patient, especially in acute phase, may help to elucidate the etiology of acute infantile hemiplegia.

Topics: Brain; Cerebrovascular Circulation; Hemiplegia; Humans; Infant; Male; Organotechnetium Compounds; Oximes; Perfusion; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Acetazolamide; Brain; Child, Preschool; Female; Hemiplegia; Humans; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The popular concept that cerebral ischemia causes transient global amnesia has been difficult to prove by cerebral blood flow studies during attacks because the transient global amnesia attacks are so short.. We performed single-photon emission computed tomography (SPECT) of the brain and neuropsychological assessment in a 37-year-old woman during a 10-hour attack and twice thereafter. A neuropsychological evaluation 3 hours after the onset of transient global amnesia revealed severe impairment of recent memory and verbal fluency, both of which returned to normal 2 and 28 days later, respectively. A 99mTc-labeled hexamethylpropyleneamine oxime SPECT of the brain performed 6 hours after the onset showed multiple perfusion defects in both occipital lobes, the medial left temporal lobe, and the left thalamus. A second brain SPECT performed 3 days later showed perfusion defects in only the occipital regions. A third brain SPECT performed 28 days later was normal. The patient's brain computed tomographic scan, electroencephalogram, duplex ultrasound of the carotid artery, and echocardiogram were normal.. The perfusion defects revealed by the brain SPECT during the transient global amnesia attack indicated ischemia in the territory of the posterior cerebral arteries, which partially resolved in 3 days and completely resolved by 28 days.

Topics: Adult; Amnesia; Brain Ischemia; Female; Hemiplegia; Humans; Neurologic Examination; Occipital Lobe; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Temporal Lobe; Thalamus; Tomography, Emission-Computed, Single-Photon

Alterations in regional cerebral blood-flow, as determined by single-photon emission computed tomography (SPECT) using technetium [99mTc] hexamethyl propylenamine oxime, were studied in two children presenting with alternating hemiplegia of childhood. Both experienced hemiplegic episodes several times per month, despite marked improvement on flunarizine therapy. SPECT images of both patients revealed focal areas of decreased uptake of the radiotracer, representing impaired regional cerebral blood-flow during, as well as between, seizures. The interictal finding of localized areas of reduced tracer uptake suggest that long-lasting hypoperfusion could be the pathophysiological mechanism by which the slowly resolving hemiplegia, and ultimately the permanent multifocal neurological deficits, are produced.

Topics: Brain; Brain Diseases; Cerebrovascular Circulation; Child, Preschool; Female; Flunarizine; Functional Laterality; Hemiplegia; Humans; Intellectual Disability; Language Disorders; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Alternating hemiplegia of childhood is a rare disorder of unknown cause associated with progressive neurological deterioration. We report the results of regional cerebral blood flow studies using 99mTc-hexamethylpropylene amine oxime single-photon emission computed tomography in 3 patients. These studies were performed during the hemiplegic attacks (n = 6) and during the symptom-free periods (n = 2). Six single-photon emission computed tomographic studies performed during hemiplegic attacks consistently showed relative hyperperfusion of the contralateral cerebral hemisphere. Two single-photon emission computed tomographic studies performed during the asymptomatic phase showed normal and symmetrical cerebral perfusion. This is the first definite demonstration of unilateral increase of cerebral blood flow in alternating hemiplegia. These findings support the possibility of a relationship between the cause of alternating hemiplegia and migraine.

Topics: Brain; Cerebrovascular Circulation; Child; Child, Preschool; Female; Hemiplegia; Humans; Male; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed

The authors describe a patient with Rasmussen's syndrome detected by grossly abnormal results of Tc-99m HMPAO SPECT brain imaging obtained with a single-headed camera. Results of magnetic resonance imaging and cerebrospinal fluid examinations were normal.

Topics: Brain; Child, Preschool; Chronic Disease; Encephalitis; Epilepsies, Partial; Female; Hemiplegia; Humans; Organotechnetium Compounds; Oximes; Syndrome; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Single Photon Emission Computed Tomography (SPECT) after intravenous administration of Technetium-99m hexamethylpropylene-amine oxime (Tc-99m HM-PAO) makes possible the evaluation of cerebral perfusion. We have been assessing the diagnostic accuracy of SPECT in some groups of head trauma patients: the preliminary results of this study are presented. Fourteen patients have been selected, all of them showing some kind of focal neurological deficit; the Computed Tomography (CT) and Nuclear Magnetic Resonance (NMR) were normal, or showed lesions that could not be responsible for the neurological deficits. In all of the patients Tc-99m HM-PAO SPECT has been performed, showing changes in cerebral perfusion in areas correlated with the abnormalities elicited on clinical examination. These results show that Tc-99m HM-PAO SPECT is a better technique than CT or NMR in demonstrating the organic basis of some neurological deficits observed after head trauma.

Topics: Adolescent; Adult; Blood-Brain Barrier; Brain; Brain Damage, Chronic; Brain Injuries; Dominance, Cerebral; Female; Glasgow Coma Scale; Head Injuries, Closed; Hemiplegia; Humans; Male; Middle Aged; Neurologic Examination; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A hemiparetic and aphasic patient, 3 days after acute traumatic transection of the left internal carotid artery requiring life-saving total embolic occlusion, revealed ipsilateral increased peripheral hemispheric 99mTc-HMPAO activity. Ten days postocclusion, HMPAO peripheral cortical flow normalized as hemiparesis and aphasia significantly cleared. The initial lateralized HMPAO hyperactivity pattern may reflect reactive hyperemia, a sign previously identified by contrast angiography and often associated with a better prognosis in evolving CVA. Evanescent peripheral cerebral hyperemia may represent beneficial cortical collateralization of the periinfarct area of a deeper lacunar (white matter) CVA.

Topics: Aphasia, Broca; Carotid Artery Injuries; Carotid Artery, Internal; Cerebral Cortex; Cerebrovascular Circulation; Embolization, Therapeutic; Hemiplegia; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Wounds, Gunshot