technetium-tc-99m-exametazime and Leukocytosis

A heart transplant patient treated with OKT3 developed a severe headache which worsened and was accompanied by a sudden decrease in the patient's consciousness level and aphasia when the treatment course was completed. CT was performed and was normal. SPET imaging with 99mTc-HMPAO of cerebral blood flow done 16 hours later revealed multiple and clear focal defects in the blood flow. Analysis of cerebral spinal fluid revealed aseptic pleocytosis. Five days after the completion of treatment, the symptoms remitted and a new control SPET 3 weeks later was completely normal. A diagnosis of neurotoxicity secondary to OKT3 administration was established.

Topics: Adult; Aphasia; Brain Abscess; Brain Edema; Cardiomyopathy, Dilated; Cerebral Hemorrhage; Cerebrospinal Fluid; Cerebrovascular Circulation; Confusion; Diagnosis, Differential; Headache; Heart Transplantation; Humans; Immunosuppressive Agents; Leukocytosis; Lymphocyte Activation; Male; Meningoencephalitis; Muromonab-CD3; Postoperative Complications; Radiopharmaceuticals; T-Lymphocytes; Technetium Tc 99m Exametazime; 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

A 19-year-old woman with active Crohn's disease under immunosuppressive therapy underwent scintigraphy with 99mTc-anti-NCA-95 antigranulocyte antibodies in order to determine the extent of inflammation. It turned out to be falsely negative whereas a 99mTc-HMPAO-labelled leukocyte scan revealed a marked terminal ileitis and pancolitis. It is assumed that immunosuppressive therapy was the main reason for the falsely negative antibody scan, possibly affecting the red bone marrow where most of the antibodies bind to granulocytes. Peripheral leukocytes labelled in vitro do not seem to be subject to these hypothetical effects on red bone marrow.

Topics: Adult; Antibodies, Monoclonal; Crohn Disease; False Negative Reactions; Female; Granulocytes; Humans; Inflammation; Leukocytes; Leukocytosis; Organotechnetium Compounds; Oximes; Radiography; Radioimmunodetection; Technetium Tc 99m Exametazime