technetium-tc-99m-exametazime and Migraine-Disorders

Headache in systemic lupus erythematosus (SLE) is controversial, as is evidence of brain impairment in patients with SLE and headache. Perfusion single photon emission computed tomography (SPECT) was performed to investigate brain impairment in SLE patients with migraine-like headache either from the period of diagnosis or later in the course of disease.. Eighteen patients with SLE (mean age 40.8 +/- 13.6 yrs) matching these characteristics underwent brain SPECT with 99mTc-HMPAO in the interictal period. Electroencephalography (EEG) and magnetic resonance imaging (MRI) were performed in 12 and 10 patients, respectively. SPECT was analyzed through visual and asymmetry combined analysis as well as by voxel-based statistical analysis compared to a control group of matched healthy subjects (statistical threshold: p = 0.01).. Focal hypoperfusion was evidenced in 15 (83%) patients, often matching the main side of pain location, whereas EEG and MRI each gave a positive result in 50% of cases. Using voxel-based analysis, significant hypoperfusion was found in 8 (44%) patients, either lateralized to one side or localized to the anterior cingulate cortex, independent of pain location.. Brain perfusion SPECT is a sensitive tool for identifying brain impairment in SLE-related migraine, although the mechanisms of brain damage remain to be elucidated. Besides confirming focal hypoperfusion in some patients, in 4 patients statistical analysis revealed interictal hypofunction of the anterior cingulate cortex, a key structure for cortical elaboration of pain in the midline network.

Topics: Adult; Brain; Case-Control Studies; Cerebrovascular Circulation; Electroencephalography; Female; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Male; Middle Aged; Migraine Disorders; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Dynamic imaging of the inflow of technetium-99m hexamethylpropylene amine oxime (HMPAO) to the brain has been proved to allow estimation of the hemispherical cerebral blood flow (CBF) using the Patlak plot. In this study, we compared the hemispherical CBF (in ml/min/100 g) of different patient groups. A total of 25 patients (comprising 13 with migraine and 12 scheduled for endarterectomy owing to angiographically confirmed severe stenosis of the internal carotid artery on at least one side) underwent baseline and acetazolamide 99mTc-HMPAO brain perfusion studies. In addition, acetazolamide 99mTc-HMPAO studies were performed in 12 healthy subjects (no baseline study was performed for ethical reasons.) Dynamic studies were acquired by means of a dual-detector gamma camera with a large field of view (HELIX, Elscint). Special difference images were created to make definition of the aortic arch and hemispherical brain regions easier and more reproducible. A semi-automatic method was developed to determine the transit time from the aorta to the brain, making the generation of the Patlak plot even more robust. The baseline CBF values did not significantly depend on the disease (P>0.1), whereas the CBF values obtained after acetazolamide provocation did do so (ANOVA, P<0.001). Patients suffering from migraine showed a significant increase in global CBF values after acetazolamide provocation (paired t test, P<0.05), but we could not find any effect of the provocation in patients awaiting carotid endarterectomy, indicating a lack of cerebrovascular reserve capacity. Comparison of the results of the acetazolamide study in patients and the control group revealed the CBF values to be significantly lower in patients with carotid stenosis (two-sample t-test, P<0.001), but not in those with migraine (P>0.1). In summary, using quantitative analysis of 99mTc-HMPAO brain studies we could objectively compare the CBF of patients suffering from different diseases. Especially the CBF values obtained after acetazolamide provocation permitted effective differentiation of disease states. The quantitative results may be of assistance in therapy planning, e.g. in selection of the correct operative technique.

Topics: Acetazolamide; Adult; Aged; Carotid Stenosis; Case-Control Studies; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Migraine Disorders; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The purpose of the present study was to evaluate neuropsychological performance and regional cerebral blood flow in migraine patients, and to investigate whether possible abnormalities in any of these fields could be related to the chronicity of the disease. The sample included 60 patients and 30 healthy control subjects; all of them were subjected to a complete neuropsychological assessment, including emotional variables. In addition an interictal 99Tc-HMPAO SPECT was performed in 56 patients and 15 controls. Disturbances in memory, attention and visuomotor speed processing were observed among migraineurs experiencing higher frequency of attacks and in those with a long history of migraine. Anxiety levels were higher in patients than in controls and were positively correlated with attack frequency, but not with cognitive test scores. Brain perfusion abnormalities, mostly hypoperfusion areas, were found in the 43% of patients; poorer performance in two tests, measuring verbal and visual memory, respectively, was found in these patients.

Topics: Adolescent; Adult; Aged; Anxiety; Attention; Brain; Cerebrovascular Circulation; Cognition Disorders; Female; Humans; Male; Memory Disorders; Middle Aged; Migraine Disorders; Neuropsychological Tests; Psychomotor Performance; Reaction Time; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Humans; Migraine Disorders; Radiopharmaceuticals; Self Administration; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Adolescent; Brain; Child; Female; Functional Laterality; Humans; Male; Migraine Disorders; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Migraine is considered to be a functional neurological disorder. For several years cerebral blood flow studies have been fueling the controversy surrounding the pathophysiology of migraine headache. Tc-99m HMPAO SPECT brain imaging was performed during the headache-free period in 44 migraineurs. The findings were compared with those of age 17 and sex-matched controls. The SPECT analysis was performed by using a 360 degrees rotating single head gamma camera system (Toshiba GCA 602A/SA, Japan), equipped with a LEAP collimator, interfaced to a Toshiba computer system, after 20 minutes following the injection of 350-550 MBq of Tc-99m HMPAO. The SPECT images revealed clear interhemispheric asymmetry in the upper frontal and occipital parts of the brain in migraineurs. It is suggested that an impaired regional cerebral vascular autoregulation may exist even during headache-free intervals in patients suffering from migraine.

Topics: Adolescent; Adult; Case-Control Studies; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Migraine Disorders; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Single photon emission computed tomography (SPECT) was performed on 30 juvenile patients suffering from different types of migraine with aura. SPECT was carried out only during the pain-free interval in 11 patients. The other 19 patients underwent SPECT ictally and 9 of them also interictally. During the pain-free interval, the investigation was normal in 16 of 20 cases and revealed hypoperfused areas in 4 of 20 cases. Ictally, regional cerebral blood flow (rCBF) abnormalities were found in 14 of 19 cases; hypoperfusion in 11 patients and hyperperfusion in 3 patients. In most cases, rCBF abnormalities corresponded to the topography of neurologic symptoms. Our interictal period results do not agree with the previous studies in juvenile migraineurs, while during the ictal phase we demonstrated, for the first time, significant rCBF abnormalities in juvenile patients suffering from migraine with aura.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Child; Female; Humans; Male; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

It is generally agreed upon that the attacks of migraine with aura are indicative of abnormal cerebral perfusion, while the permanence of such perfusion abnormalities during the pain-free intervals of migraine remains debated. This study was aimed at assessing: 1) the presence of cerebral perfusion abnormalities also during the interictal phase and 2) the role of SPET with 99mTc HM-PAO to diagnose migraine. Twenty-eight patients (22 women and 6 men), diagnosed as having migraine with aura according to the International Headache Society (Headache Classification Committee criteria), were submitted to SPET studies, within 10 days of the last attack. 99mTc HM-PAO was used as perfusion tracer and a single head rotating gamma camera equipped with a high-resolution collimator was used for data acquisition. The qualitative analysis of SPET images showed slight hypoperfusion areas in 22 of 28 patients (79%). In 12 of 22 patients (55%) a regional correlation was observed between hypoperfusion areas and the neurologic symptoms of aura. The results of the present study are in agreement with the current physiopathologic interpretation of migraine with aura, confirming the instability of cerebral perfusion control, even with instrumental evidence of perfusion abnormalities in the interictal period. Moreover, SPET with 99mTc Hm-PAO seems to be a useful tool in the diagnostic assessment of migraine.

Topics: Adolescent; Adult; Brain; Evaluation Studies as Topic; Female; Humans; Male; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The authors present a case of basilar artery migraine in a 33-year-old woman who was initially misdiagnosed as having a cerebrovascular or mental disorder and subjected to MRI and cerebral angiography, which, however, did not show any pathologic findings. During admission to the university hospital, she lost consciousness. An emergency Tc-99m HMPAO brain SPECT showed a significant decrease of regional cerebral blood flow in the right temporal and occipital cortices, and right cerebellar hemisphere, where regional cerebral blood flow was decreased by 10-24% as compared to the left side. The second brain SPECT during a symptom-free phase showed the reversion of regional cerebral blood flow to normal in these areas. Basilar artery migraine was diagnosed by the finding of reversible ischemia in the territory of the right basilar artery on brain SPECT images and the clinical picture.

Topics: Adult; Brain; Cerebrovascular Circulation; Cerebrovascular Disorders; Diagnostic Errors; Female; Humans; Mental Disorders; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Vertebrobasilar Insufficiency

Acetazolamide, a carbonic anhydrase inhibitor, has proved to be useful in the assessment of "vasodilatory capacity" in cerebrovascular disease. To obtain further information on the nature of interictal low-flow regions in migraine, we reinvestigated 20 asymptomatic patients suffering from migraine with aura (n = 15) or without aura (n = 5) and who had either minor (n = 12) or marked (n = 8) regional hypoperfusion when examined in a previous 99mTc-HMPAO SPECT investigation. These patients received acetazolamide IV prior to tracer application. In 14/20 cases regional hypoperfusion resolved. Three patients with migraine with aura had less pronounced regional hypoperfusion compared to baseline. No change in baseline hypoperfusion was detectable in three older patients. No further decreases in flow were measured. In contrast to patients with cerebrovascular ischemia, in whom acetazolamide usually enhances low-flow regions, vasodilatory capacity appears intact in most migraine patients with interictal regional hypoperfusion. Thus, the "acetazolamide test" might be useful in the differential diagnosis of migraine with aura from transient cerebrovascular ischemia.

Topics: Acetazolamide; Adult; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

The recent development of SPECT has introduced a new procedure to evaluate neurological diseases. By mean of Tc99mHM-PAO we studied a group of 19 pediatric subjects (7 males and 12 females) with different form of migraine, within five days after the last headache attack. Postictally SPECT shows regionally decreased CBF in 3/4 of HM, in 5/6 of BAM, in 5/5 of CM and in 2/4 of M.

Topics: Adolescent; Cerebrovascular Circulation; Child; Female; Flunarizine; Humans; Male; Migraine Disorders; Organotechnetium Compounds; Oximes; Pizotyline; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

An unusual case of an abnormally long-lasting (over 12 months) visual migraine aura is reported. The absence of signs of a structural lesion, as shown by neuro-imaging and clinical investigations, make difficult the differential diagnosis between a new variation and a complication of migraine.

Topics: Aged; Female; Humans; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Vision Disorders

The authors report the results of a retrospective controlled study on the incidence of migraine in centro-temporal epilepsy compared to absence epilepsy, partial epilepsy and a group of patients with cranial trauma without epilepsy. The following observations from this series of 129 patients were made. Migraine was present in 63% of the patients with centro-temporal epilepsy (rolandic epilepsy), in 33% with absence epilepsy, in 7% with partial epilepsy and in 9% of the cranial trauma group. These results suggest that the association of centro-temporal epilepsy and migraine is non-fortuitous and also to a lesser degree in absence epilepsy. The role of neurotransmitters in this association is discussed. No decrease in cerebral blood flow was observed in 12 patients with rolandic epilepsy on a Hm-PAO SPECT study.

Topics: Adolescent; Brain Injuries; Chi-Square Distribution; Child; Electroencephalography; Epilepsies, Partial; Epilepsy, Absence; Female; Follow-Up Studies; Humans; Male; Migraine Disorders; Organotechnetium Compounds; Oximes; Retrospective Studies; Technetium Tc 99m Exametazime; Time Factors; Tomography, Emission-Computed, Single-Photon

Five patients presenting with migraine attacks underwent Electroencephalography (EEC), Computed Tomography (CT) and Single Photon Emission Tomography (SPECT) with 99mTc-HM PAO. EEG and SPECT were subsequently repeated in the intercritical period. We observed that: two patients only showed non-specific abnormalities in EEG; scans were normal in all patients; all subjects exhibited diffuse cortical hypoperfusion. A strong correlation was always found between clinical presentation and hemispheric impairment. One patient exhibited asymmetrical perfusion between cerebellum hemispheres; intercritical SPECT showed homogeneous distribution of the radio-tracer in four patients. In the last one minimal residual hypoperfusion was observed, although less marked than in the acute phase. Therefore SPECT with 99mTc-HM PAO can be reasonably employed as the examination of choice when a migraine attack is clinically suspected, because of its reproducibility and reliability. It can be easily performed in every nuclear medical center supplied with modern tomographic gamma-cameras.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Electroencephalography; Evaluation Studies as Topic; Female; Humans; Male; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Both CBF and CBV were evaluated by gamma-camera SPECT in 14 patients with classic migraine, all studied while symptom-free. Nuclear data were correlated with CT and MRI. A decreased regional CBF was observed in 13 of the 14 patients. The decreased perfusion was localized in the frontal lobe in 6 patients, the temporal lobe in one, the parietal lobe in 11 and the occipital lobe in 5 patients. The parieto-occipital cortex was involved more often than the frontal cortex; the association of hypoperfusion with parieto-occipital cortex was quite high. The right parieto-occipital regions were affected more often than the left ones. Regional CBV was increased in 8 patients. There was good topographical concordance between decreased CBF and increased CBV, but the increase of CBV was in general more evident at the periphery of the hypoperfusion. It is of interest that the only patient with a normal CBF study had a pathological CBV study. Apparently, CBF derangements are very common in symptom-free patients with classic migraine, a CBF decrease being often accompanied by a CBV increase. In these patients both CT and MRI have a lower diagnostic yield than SPECT.

Topics: Adolescent; Adult; Aged; Blood Volume; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The case of a 69-year-old woman with chronic paroxysmal hemicrania (CPH) is presented in whom cerebral perfusion was investigated using the flow tracer 99mTc-hexamethyl propylenamino oxime (HMPAO) and single photon emission tomography (SPECT). There was a bilateral hypoperfusion in the fronto-parietal region between attacks--without medication as well as under effective treatment with verapamil. During an attack, however, SPECT investigation showed a normal cerebral perfusion. Further investigation is required to find out whether these SPECT findings are due to primary alterations of brain perfusion in CPH or are only of epiphenomenological nature. The observed effectiveness of verapamil in the prophylactic treatment of CPH should be verified in a greater number of patients.

Topics: Aged; Chronic Disease; Female; Humans; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The relative importance of vascular vs neurological mechanisms in the pathogenesis of classical migraine remains unresolved. This article examines the current radiological evidence and discusses the possible future contributions of radiological imaging techniques in elucidating this puzzling clinical entity.

Topics: Brain; Cerebral Angiography; Humans; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Xenon Radioisotopes

Thirty-three headache-free patients (19 F/14 M) suffering from common (n = 9) and classic migraine (n = 19) as well as cluster headache (n = 5) were investigated using the flow tracer 99mTc-hexamethyl propylenamino oxime and single photon emmission computed tomography. A regional decrease of cerebral tracer uptake was observed in 16 patients with common migraine, but only in 3 patients with classic migraine and in no patient with cluster headache. In 10 of 15 cases with hemiplegic symptoms during migraine attack the areas of decreased tracer uptake showed a topographic relationship to neurological deficits. It appears that migraine attacks occur in connection with exacerbations of preexisting changes of neuronal activities, cerebral perfusion and metabolism.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Cluster Headache; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Migraine Disorders; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed; Vascular Headaches

Topics: Adult; Aged; Brain; Brain Neoplasms; Cerebrovascular Circulation; Female; Humans; Male; Migraine Disorders; Organometallic Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed