technetium-tc-99m-exametazime and Sclerosis

We compared the results of comprehensive scintigraphic examination of 35 patients with suspected myocarditis and the data of clinical, immunological, laboratory and instrumental studies. The patients were divided into 3 groups. Group 1 included 11 patients with preliminary diagnosis of acute myocarditis, group 2--11 patients with chronic myocarditis, group 3--13 patients with postmyocarditic cardiosclerosis. All patients were tested for antimyocardial antibodies, underwent 99mTc-HMPAO-labeled leukocyte and perfusion scintiography of myocardium. The study did not reveal significant differences between the three groups as regards the results of laboratory and instrumental studies. Elevated titers of antimyocardial antibodies were found in 70% of the patients in group 1, 100% in group 2, and 46% in group 3. Patients with chronic myocarditis had the highest titers of antibodies. Pathological accumulation of 99mTc-HMPAO-labeled leukocytes in myocardium was documented in 36.4 and 81.8% of the patients of groups 1 and 2 respectively. They were absent in the heart of group 3 patients. Disturbed myocardial perfusion was recorded in 45.5, 81.8 and 84.6% in groups 1, 2 and 3 respectively. The magnitude of accumulation of leukocytes was not significantly different between the groups. Results of the study suggest rather high specificity of radionuclide techniques for diagnostics of inflammatory lesions in myocardium. However, further studies are needed to confirm their sensitivity and accuracy.

Topics: Adult; Autoantibodies; Female; Heart; Humans; Leukocytes; Male; Myocarditis; Myocardium; Radionuclide Imaging; Radiopharmaceuticals; Sclerosis; Technetium Tc 99m Exametazime; Young Adult

The aims of the present study were to explore the relation between ictal scalp EEG patterns and ictal hyperperfusion patterns in patients with unilateral hippocampal sclerosis-associated mesial temporal lobe epilepsy (HS-MTLE) by using semiquantitative single-photon emission computed tomography (SPECT) analysis and to assess clinical significance of ictal hyperperfusion patterns.. We studied retrospectively 39 consecutive patients with surgically proven HS-MTLE. All had both interictal and ictal SPECTs with the tracer injection during a complex partial seizure (CPS) typical of MTLE semiology. According to initial ictal discharge (IID) frequency on scalp EEG, two lateralizing patterns were identified: (a) a sustained regular 5- to 9-Hz rhythm with a restricted temporal or subtemporal distribution (group 1); and (b) an irregular 2- to 5-Hz rhythm with a widespread distribution (group 2). We performed group analysis by using statistical parametric mapping (SPM) of paired ictal-interictal SPECTs to identify regions of significant ictal hyperperfusion and compared clinical characteristics, tracer-injection time, semiology, pathologic HS grade, and surgical outcome between two groups.. Of the 39 patients, 19 patients (10 males, nine right HS) were designated as group 1, and the remaining 20 patients (eight males, seven right HS), group 2. Group 1 showed hyperperfusion mainly confined to the ipsilateral temporal lobe, whereas group 2 showed widespread hyperperfusion in the extratemporal structures such as ipsilateral basal ganglia, brainstem, and bilateral thalamus, in addition to the ipsilateral temporal lobe. No significant difference was found between two groups in clinical characteristics, injection time, pathologic HS grade, and surgical outcome. Among semiologic features, dystonic limb posturing was more frequently observed in group 2 (p = 0.006).. Scalp EEG IID frequency in HS-MTLE can be an important determining factor of ictal hyperperfusion patterns. The lack of difference in surgical outcome between two groups implies that different hyperperfusion patterns, according to their IID frequencies, reflect only preferential pathways of ictal propagation rather than intrinsic epileptogenic region.

Topics: Adult; Electroencephalography; Epilepsy, Temporal Lobe; Female; Functional Laterality; Hippocampus; Humans; Male; Regional Blood Flow; Retrospective Studies; Sclerosis; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Intermittent photic stimulation (IPS) may produce epileptiform discharges and seizures, most of which are generalized. There are several cases of focal seizures of occipital origin induced by IPS and only five reported cases originating from the temporal lobe (TL). We report an unusual case of TL epilepsy, supported by electroclinical and neuroimaging data, with rhythmic focal TL discharges precipitated by photic stimulus.. A 37 year old male with refractory epilepsy due to a right mesial temporal sclerosis presented a focal right TL photoparoxysmal response during IPS. A routine, interictal SPECT study obtained with injection of HMPAO, carried out during continuous pulses of the photic stimulus at 16 Hz, disclosed hyperperfusion over the right TL. Presurgical ictal studies demonstrated seizures arising from the same region. A temporal lobectomy rendered the patient seizure-free and further EEGs with IPS were normal.. To our knowledge, this is the sixth case in medical literature showing evidence of photosensitivity associated with a TL lesion and it is the first in which photic stimulation induced a focal electrographic response of the involved TL. We hypothesize that in rare cases, photosensitivity may be related to a mesial TL lesion without occipital cortex involvement.

Topics: Adult; Cerebrovascular Circulation; Electroencephalography; Epilepsy, Reflex; Epilepsy, Temporal Lobe; Humans; Male; Memory; Neuropsychological Tests; Neurosurgical Procedures; Photic Stimulation; Radiopharmaceuticals; Sclerosis; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon

We sought to determine whether patterns of ictal hyperfusion demonstrated using [99mTC]HMPAO (hexamethylpropylene amine oxime) single photon emission computed tomography (SPECT) predict outcome of temporal lobectomy; in particular, whether the more extensive patterns of ictal hyperperfusion are associated with poor outcome. We studied 63 patients who had ictal SPECT studies prior to temporal lobectomy. Hyperperfusion on ictal SPECT scans was lateralized, and classified into: (i) 'typical', (ii) 'typical with posterior extension', (iii) 'bilateral' and (iv) 'atypical' patterns. Outcome (minimum of 2 years follow-up) was classified as either seizure free, or not seizure free. Actuarial analysis was used to test the relationship of SPECT patterns with outcome. There were 35 cases with the typical ictal SPECT pattern, 13 posterior, nine bilateral and six atypical cases. The atypical pattern was associated with lack of pathology in the surgical specimen. Outcome was similar for the typical, posterior and bilateral with 60%, 69% and 67% seizure free, respectively. In contrast, the atypical group had a worse outcome with only 33% seizure free. Actuarial analysis showed a significant difference in outcome between patients with the typical pattern, and patients with the atypical pattern (P = 0.04). We conclude that extended patterns of ictal perfusion in temporal lobe epilepsy do not predict poor outcome, indicating that extended hyperperfusion probably represents seizure propagation pathways rather than intrinsically epileptogenic tissue. Atypical patterns of hyperperfusion are associated with poor outcome and may indicate diffuse or extra-temporal epileptogenicity.

Topics: Actuarial Analysis; Adolescent; Adult; Cerebrovascular Circulation; Epilepsy, Temporal Lobe; Female; Follow-Up Studies; Humans; Male; Middle Aged; Observer Variation; Retrospective Studies; Sclerosis; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Treatment Outcome