technetium-tc-99m-exametazime and Substance-Withdrawal-Syndrome

Regional brain perfusion in patients during alcohol-withdrawal has been relatively less studied with brain SPECT technique. In this study, the hypothesis that possible regional cerebral blood flow (rCBF) alterations due to alcohol withdrawal might be transitory in a homogenous group of alcoholic patients in terms of their physical-nutritional and cognitive functional conditions was investigated.. Fifteen right-handed male inpatients with alcohol-withdrawal, diagnosed according to DSM-IIIR criteria, and 6 male physically-mentally healthy control subjects were included in the study. The first Technetium 99m-hexamethylpropyleneamineoxime (Tc-99m-HMPAO) brain SPECT investigation was performed on the day of admission in nonmedicated conditions and the second one was performed after all the withdrawal symptoms had subsided in the patients. As an indicator of the change in the brain perfusion, a relative perfusion index was used and the relative tracer activity was expressed as the ratio of mean cortical region of interest activity to mean the whole cortical brain activity.. We found significantly reduced left frontal and right frontal, parietal and temporal rCBF values in the patients during the alcohol-withdrawal compared to those of their remitted state while they were not different from in the control group (p < 0.05).. Our data indicate that the alterations in rCBF during the alcohol-withdrawal are more pronounced both in the frontal cortex and in overall right hemisphere regions. Furthermore, the frontal hypoperfusion may be transitory with recovery from alcohol-withdrawal whereas temporal hypoperfusion may continue after recovery probably depending on the previously administered high-dose benzodiazepines.

Topics: Adult; Alcoholism; Central Nervous System Depressants; Cerebrovascular Circulation; Ethanol; Frontal Lobe; Humans; Male; Middle Aged; Substance Withdrawal Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Aged, 80 and over; Benzodiazepines; Brain; Cerebrovascular Circulation; Female; Humans; Radiopharmaceuticals; Seizures; Substance Withdrawal Syndrome; Suicide, Attempted; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Cerebral perfusion abnormalities and neuropsychological impairment are common sequelae of chronic cocaine abuse. While perfusion abnormalities have been shown to relate to cognitive deficits in this substance abuse population, the relationship between cognitive performance and the magnitude of perfusion abnormality has yet to be fully determined.. Thirty-seven abstinent cocaine abusers and 13 normal controls were administered resting 99m-Tc-HMPAO single photon emission computed tomography (SPECT) scans followed by a neuropsychological assessment battery tapping executive skills, attention, memory, and motor performance. Statistical parametric mapping (SPM99) techniques were used to analyze the SPECT data to detect significant regional perfusion abnormalities in the cocaine group relative to normal controls, and resulting abnormal SPECT counts were employed for comparison with the assessment measures to examine the relationship between cocaine-induced perfusion abnormalities and cognitive performance.. SPECT data analysis revealed significant regional perfusion abnormalities in the cocaine abuse sample relative to controls and significant differences in neuropsychological functioning on measures of executive functioning, complex attention, memory, and manual dexterity. For chronic cocaine abusers, however, within-group comparisons of the magnitude of abnormal perfusion and neuropsychological performance were largely nonsignificant, with the exception of complex attention and motor speed.. Perfusion abnormalities and neuropsychological impairments readily distinguished cocaine abusers from normal controls. However, when the magnitude of cocaine-induced perfusion abnormalities is examined in relation to cognitive performance, motor speed and complex attention appear to be the best behaviorial indicants of the severity of perfusion dysfunction within this substance abuse population.

Topics: Adolescent; Adult; Cerebral Cortex; Cocaine; Cocaine-Related Disorders; Cognition Disorders; Female; Humans; Image Processing, Computer-Assisted; Male; Neuropsychological Tests; Psychometrics; Reference Values; Regional Blood Flow; Reproducibility of Results; Substance Withdrawal Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

A 29-y-old man had taken small daily doses of barbiturates as hypnotics (50 mg pentobarbital, 30 mg phenobarbital) for 4y with no evident intoxication. When he attempted suicide by ingestion of 15 g amobarbital, treatment with charcoal hemoperfusion resulted in rapid disappearance of drug from the blood. Generalized convulsions and delirium ensued; these were responsive to phenobarbital. An electroencephalogram (EEG) showed diffuse 5-Hz theta activity. Tc-99m hexamethylpropyleneamineoxime (HMPAO) single photon emission computed tomographic (SPECT) imaging of the brain demonstrated a diffuse bilateral decrease in blood flow to the cerebral cortex. These investigations were performed interictally on day4 without sedative drugs, prior to initiation of anticonvulsants, and at a time when barbiturates were no longer detected in the serum. An EEG on day 15 no longer showed abnormal slowing. On the other hand, Tc-99m HMPAO SPECT of the brain demonstrated residual cerebral hypoperfusion on day 20, with nearly full recovery of cerebral perfusion on day 51. Barbiturate withdrawal syndrome is presumed to require a history of abuse; however in patients with a history of treatment with barbiturates physicians treating acute barbiturate poisoning should be alert for the possibility of barbiturate withdrawal syndrome even in the absence of barbiturate abuse.

Topics: Adult; Barbiturates; Brain; Humans; Male; Seizures; Substance Withdrawal Syndrome; Suicide, Attempted; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The aims of the present study were to investigate regional cerebral blood flow (rCBF) in heroin-dependent patients during withdrawal and to assess the relation between these changes and duration of heroin consumption and withdrawal data. The rCBF was measured using brain SPECT with 99mTc-HMPAO in 16 heroin-dependent patients during heroin withdrawal. Thirteen patients received levomethadone at the time of the SPECT scans. The images were analyzed both visually and quantitatively. A total of 21 hypoperfused brain regions were observed in 11 of the 16 patients. The temporal lobes were the most affected area, hypoperfusions of the right and left temporal lobe were observed in 5 and 5 patients, respectively. Three of the patients had a hypoperfusion of the right frontal lobe, 2 patients showed perfusion defects in the left frontal lobe, right parietal lobe and left parietal lobe. The results of the quantitative assessments of the rCBF were consistent with the results of the qualitative findings. The stepwise regression analysis showed a significant positive correlation (r = 0.54) between the dose of levomethadone at the time of the SPECT scan and the rCBF of the right parietal lobe. Other significant correlations between clinical data and rCBF were not found. The present results suggest brain perfusion abnormalities during heroin withdrawal in heroin-dependent patients, which are not due to the conditions of withdrawal.

Topics: Adult; Basal Ganglia; Brain; Cerebral Cortex; Cerebrovascular Circulation; Female; Heroin Dependence; Humans; Male; Methadone; Narcotics; Radiopharmaceuticals; Regression Analysis; Substance Withdrawal Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Early manic relapse following lithium discontinuation offers an important opportunity to investigate the relationship between symptoms, effects of treatment and regional brain activation in bipolar affective disorder.. Fourteen stable bipolar patients on lithium were examined with neuropsychological measures, clinical ratings and single photon emission computed tomography (SPECT) before and after acute double-blind withdrawal of lithium. Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric analysis was used to examine the change in brain perfusion on lithium withdrawal, and the relationship between symptom severity and brain perfusion separately both between and within subjects.. Lithium withdrawal was associated with an important redistribution of brain perfusion, with increases in inferior posterior regions and decreases in limbic areas, particularly anterior cingulate cortex. Seven of the 14 patients developed manic symptoms during the placebo phase, correlating with relative increases in perfusion of superior anterior cingulate and possibly left orbito-frontal cortex.. The important effect of lithium withdrawal on brain perfusion implies that after withdrawal of lithium, the brain develops an abnormal state of activity in limbic cortex. The structures involved did not co-localise with those apparently modulated by manic symptoms.

Topics: Antimanic Agents; Bipolar Disorder; Female; Humans; Lithium Carbonate; Male; Middle Aged; Organotechnetium Compounds; Oximes; Substance Withdrawal Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

An alcohol- and diazepam-abusing patient underwent brain CT and SPECT imaging studies. The CT scan showed mild brain atrophy, whereas SPECT imaging using Tc-99m HMPAO showed a large lesion in the left cerebral hemisphere. The extent of lesion involvement was appreciated by three-dimensional displays. This finding was associated with a clinical presentation of hypnosedative withdrawal delirium (disorientation, impaired memory, rambling speech with loose associations, paranoia, ideation, restlessness, poor judgment). Tc-99m HMPAO SPECT may provide objective documentation of regional cerebral neurochemical alteration associated with hypnosedative abuse or hypnosedative withdrawal states, whereas surface and volume three-dimensional displays simplify and enhance brain SPECT image interpretation.

Topics: Alcohol Withdrawal Delirium; Brain; Diazepam; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organotechnetium Compounds; Oximes; Substance Withdrawal Syndrome; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed