scholarly journals Surgical strategy for refractory epilepsy secondary to porencephaly: ictal SPECT may obviate the need for intracranial electroencephalography. Patient series

2021 ◽  
Vol 1 (21) ◽  
Author(s):  
Naoki Ichikawa ◽  
Naotaka Usui ◽  
Akihiko Kondo ◽  
Takayasu Tottori ◽  
Tokito Yamaguchi ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Fdg Pet ◽  
Photon Emission ◽  
Intractable Epilepsy ◽  
Emission Computed Tomography ◽  
Seizure Outcome ◽  
Left Middle Cerebral Artery ◽  
Intracranial Eeg ◽  
Ictal Spect ◽  
Epileptiform Discharges

BACKGROUND Surgical treatment of intractable epilepsy caused by porencephaly can be difficult because of poorly localizing or lateralizing electroclinical findings. The authors aimed to determine whether noninvasive evaluations are sufficient in these patients. OBSERVATIONS Eleven patients were included in this study. The porencephalic cyst was in the left middle cerebral artery (MCA) area in 9 patients, the left posterior cerebral artery area in 1 patient, and the bilateral MCA area in 1 patient. Interictal electroencephalography (EEG) revealed multiregional, bilateral, interictal epileptiform discharges in 5 of 11 patients. In 6 of 10 patients whose seizures were recorded, the ictal EEG was nonlateralizing. Nine patients underwent ictal single-photon emission computed tomography (SPECT), which revealed lateralized hyperperfusion in 8 of 9 cases. Fluorodeoxyglucose positron emission tomography (FDG-PET) was useful for identifying the functional deficit zone. No patient had intracranial EEG. The procedure performed was hemispherotomy in 7 patients, posterior quadrant disconnection in 3 patients, and occipital disconnection in 1 patient. A favorable seizure outcome was achieved in 10 of 11 patients without the onset of new neurological deficits. LESSONS Ictal SPECT was useful for confirming the side of seizure origin when electroclinical findings were inconclusive. Thorough noninvasive evaluations, including FDG-PET and ictal SPECT, enabled curative surgery without intracranial EEG. Seizure and functional outcomes were favorable.

scholarly journals The slope of cerebral oxyhemoglobin oscillation is associated with vascular reserve capacity in large artery steno-occlusion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tae Jung Kim ◽  
Jae-Myoung Kim ◽  
Soo-Hyun Park ◽  
Jong-Kwan Choi ◽  
Hyeon-Min Bae ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Near Infrared ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Large Artery ◽  
Anterior Circulation ◽  
Functional Near Infrared Spectroscopy ◽  
Vascular Reserve ◽  
Photon Emission Computed Tomography

AbstractInadequate cerebral perfusion is a risk factor for cerebral ischemia in patients with large artery steno-occlusion. We investigated whether prefrontal oxyhemoglobin oscillation (ΔHbO2, 0.6–2 Hz) was associated with decreased vascular reserve in patients with steno-occlusion in the large anterior circulation arteries. Thirty-six patients with steno-occlusion in the anterior circulation arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery) were included and compared to thirty-six control subjects. Patients were categorized into two groups (deteriorated vascular reserve vs. preserved vascular reserve) based on the results of Diamox single- photon emission computed tomography imaging. HbO2 data were collected using functional near-infrared spectroscopy. The slope of ΔHbO2 and the ipsilateral/contralateral slope ratio of ΔHbO2 were analyzed. Among the included patients (n = 36), 25 (69.4%) had deteriorated vascular reserve. Patients with deteriorated vascular reserve had a significantly higher average slope of ΔHbO2 on the ipsilateral side (5.01 ± 2.14) and a higher ipsilateral/contralateral ratio (1.44 ± 0.62) compared to those with preserved vascular reserve (3.17 ± 1.36, P = 0.014; 0.93 ± 0.33, P = 0.016, respectively) or the controls (3.82 ± 1.69, P = 0.019; 0.94 ± 0.29, P = 0.001). The ipsilateral/contralateral ΔHbO2 ratio could be used as a surrogate for vascular reserve in patients with severe steno-occlusion in the anterior circulation arteries.

scholarly journals Cerebral Hemispheric and Contralateral Cerebellar Hypoperfusion during a Transient Ischemic Attack

1987 ◽  
Vol 7 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Daniela Perani ◽  
Paolo Gerundini ◽  
Gian Luigi Lenzi
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Complete Recovery ◽  
Emission Computed Tomography ◽  
Left Middle Cerebral Artery ◽  
Single Photon Emission Computed ◽  
Ischemic Attack ◽  
The Right ◽  
Photon Emission Computed Tomography ◽  
Left Middle

We studied a 79-year-old woman within 3 h of the onset of a motor aphasia and a right hemiparesis. Single photon emission computed tomography (SPECT) showed a 24% decrease in the perfusion of the left middle cerebral artery territory and a 16% reduction in the perfusion of the right cerebellum. A mild naming difficulty was the neurological deficit at the end of the SPECT examination, and complete recovery was achieved within 24 h. Repeated SPECT study 10 days later was normal. This is the first report of focal hemispheric and contralateral cerebellar hypoperfusion in transient cerebral ischemia.

Mesial Temporal Glioma

2019 ◽  
pp. 199-206
Author(s):  
Gerry Grant
Keyword(s):  
Temporal Lobe ◽  
Single Photon ◽  
Photon Emission ◽  
Psychosocial Problems ◽  
Emission Computed Tomography ◽  
Seizure Outcome ◽  
Positron Emission ◽  
Dystonic Posturing ◽  
Operative Planning ◽  
Temporal Lobe Seizure

A patient with classic temporal lobe seizure semiology may present with aura, automatisms, and dystonic posturing. Video-electroencephalography (EEG) may identify the ictal onset and magnetoencephalography may further elucidate the anatomy of a temporal lobe abnormality, EEG dipoles, epileptogenic spike sources, and eloquent areas of language or motor function. Structural imaging of the temporal lobe with magnet resonance imaging (MRI) should also be obtained, as well as functional and metabolic imaging such as a subtraction single-photon emission computed tomography (SPECT) and interictal positron emission tomography (PET). Early surgery should be considered in pediatric patients for seizure control, to minimize the adverse effects of anti-epileptic drugs, maximize the child’s developmental potential, and reduce behavioral, cognitive and psychosocial problems. Intraoperative stereotactic navigation and electrocorticography (ECoG) can guide resection. Careful pre-operative planning for correct extent of surgery is key to the best possible seizure outcome.

Is Precise Targeting of the Recipient Artery in a Superficial Temporal Artery–Middle Cerebral Artery Anastomosis Crucial?

2019 ◽  
Vol 80 (06) ◽  
pp. 441-453
Author(s):  
Hiroyuki Katano ◽  
Hiroshi Yamada ◽  
Yusuke Nishikawa ◽  
Kazuo Yamada ◽  
Shigenori Miyachi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Single Photon ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Temporal Artery ◽  
Visual Assessment ◽  
Emission Computed Tomography ◽  
Recipient Artery ◽  
Visual Group

Abstract Objective To investigate the difference in treatment outcomes according to the method used to select the recipient artery in superficial temporal artery–middle cerebral artery (STA-MCA) anastomoses. Methods We retrospectively analyzed the cases of 35 patients who underwent an STA-MCA anastomosis for internal carotid artery/MCA occlusion or stenosis. Patients were divided into two groups based on whether the recipient artery was precisely targeted by single-photon emission computed tomography (SPECT group) or less precisely targeted by visual assessment (Visual group). Then the bypass results in both groups were evaluated postoperatively based on changes in the regional cerebral blood flow (rCBF) and clinical outcomes. Results The delineated recipient artery in magnetic resonance angiography (MRA) matched the intraoperatively selected artery in 87.6% of the SPECT group cases and 83.3% of the Visual group cases. The SPECT group's digital subtraction angiography (DSA) findings coincided with the intraoperative selection in 76.9% of cases, and the MRA findings corresponded with the DSA findings in 92.3%. The postoperative areas with increased rCBF matched the perfused areas of intraoperatively selected arteries in 80.0% of the SPECT group cases and 77.8% of the Visual group cases. Postoperatively increased rCBF areas matching totally or partially with preoperative low-perfusion areas were observed in all cases. Conclusions The present results revealed no significant differences in the change in rCBF in the low-perfusion area between the patients whose recipient arteries were selected by SPECT or visual assessment.

Utility of Ictal Single Photon Emission Computed Tomography in Mesial Temporal Lobe Epilepsy With Hippocampal Atrophy

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 431-436 ◽  
Author(s):  
Tonicarlo R. Velasco ◽  
Lauro Wichert-Ana ◽  
Gary W. Mathern ◽  
David Araújo ◽  
Roger Walz ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Single Photon ◽  
Photon Emission ◽  
Mesial Temporal Lobe Epilepsy ◽  
Emission Computed Tomography ◽  
Ictal Spect ◽  
Mesial Temporal Lobe ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography ◽  
Video Eeg

Abstract BACKGROUND: The development of newer diagnostic technologies has reduced the need for invasive electroencephalographic (EEG) studies in identifying the epileptogenic zone, especially in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). OBJECTIVE: To evaluate ictal single photon emission computed tomography (SPECT) in the evaluation and treatment of patients with MTLE-HS. METHODS: MTLE patients were randomly assigned to those with (SPECT, n = 124) and without ictal SPECT (non-SPECT, n = 116) in an intent-to-treat protocol. Primary end points were the proportion of patients with invasive EEG studies, and those offered surgery. Secondary end points were the length of hospital stay and the proportion of patients with secondarily generalized seizures (SGS) during video-EEG, postsurgical seizure outcome, and hospital cost. RESULTS: The proportion of patients offered surgery was similar in the SPECT (85%) and non-SPECT groups (81%), as well as the proportion that had invasive EEG studies (27% vs 23%). The mean duration of hospital stay was 1 day longer for the SPECT group (P < 0.001). SGS occurred in 51% of the SPECT and 26% of the non-SPECT group (P < 0.001). The cost of the presurgical evaluation was 35% higher for the SPECT compared with the non-SPECT group (P < 0.001). The proportion of patients seizure-free after surgery was similar in the SPECT (59%) compared with non-SPECT group (54%). CONCLUSION: Ictal-SPECT did not add localizing value beyond what was provided by EEG-video telemetry and structural MRI that altered the surgical decision and outcome for MTLE-HS patients. Ictal-SPECT increased hospital stay was associated with increased costs and a higher chance of SGS during video-EEG monitoring. These findings support the notion that a protocol including ictal SPECT is equivalent to one without SPECT in the presurgical evaluation of adult patients with MTLE-HS.

scholarly journals Functional imaging: A necessary prerequisite to neuropsychological assessment

2014 ◽  
Vol 1 (2) ◽  
pp. 74
Author(s):  
Edward H. Tobe
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Fdg Pet ◽  
Neuropsychological Testing ◽  
Photon Emission ◽  
Pet Scan ◽  
Emission Computed Tomography ◽  
Pet Scanning ◽  
Fdg Pet Scan ◽  
Left Thalamus

After traumatic brain injury, neuropsychological testing may be insensitive in documenting functional brain injury. Imaging with single-photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scanning may identify brain injury that is missed on neuropsychological testing. A 27-year-old man had loss of consciousness after hydrogen sulfide exposure and a fall; he had markedly impaired function (short-term memory, sequential thinking, attention, and initiative), but neuropsychological testing showed only mild to moderate impairments. A 37-year-old woman had a whiplash injury and head trauma after an automobile accident; she had apprehension, dysphoria, word finding problems, impaired memory and concentration, and slowed thinking; neuropsy- chological testing was normal. In the man, SPECT scan showed decreased activity in the striatum, amygdala, and hippocampus bilaterally (decreased more in the right than left hemisphere); an FDG-PET scan showed markedly decreased metabolism in the left thalamus, heterogeneous abnormal uptake in the basal ganglia, and abnormally decreased metabolism in both temporal and inferior parietal lobes. In the woman, FDG-PET scan showed several regions of abnormal metabolic activity not restricted to single vascular territories and decreased activity in the left frontal lobe, left thalamus, and left caudate nucleus. Repeat neuropsychiatric testing in both patients showed cognitive and motor impairments that seriously limited routine activities of daily living. In summary, after traumatic brain injury associated with neuropsychological symptoms, SPECT and FDG-PET scanning may be more sensitive than neuropsychological testing in detecting objective signs of brain injury.

scholarly journals Determining Surgical Candidacy in Temporal Lobe Epilepsy

2012 ◽  
Vol 2012 ◽  
pp. 1-16 ◽  
Author(s):  
Alireza Mansouri ◽  
Aria Fallah ◽  
Taufik A. Valiante
Keyword(s):  
Magnetic Resonance ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Psychosocial Functioning ◽  
Single Photon ◽  
Selection Process ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Resonance Spectroscopy ◽  
Seizure Outcome

Temporal lobe epilepsy (TLE) is the most common form of adult epilepsy that is amenable to surgical treatment. In the carefully selected patient, excellent seizure outcome can be achieved with minimal or no side effects from surgery. This may result in improved psychosocial functioning, achieving higher education, and maintaining or gaining employment. The objective of this paper is to discuss the surgical selection process of a patient with TLE. We define what constitutes a patient that has medically refractory TLE, describe the typical history and physical examination, and distinguish between mesial TLE and neocortical TLE. We then review the role of routine (ambulatory/sleep-deprived electroencephalography (EEG), video EEG, magnetic resonance imaging (MRI), neuropsychological testing, and Wada testing) and ancillary preoperative testing (positron emission tomography, single-photon emission computed tomography (SPECT), subtraction ictal SPECT correlated to MRI (SISCOM), magnetoencephalography, magnetic resonance spectroscopy, and functional MRI) in selecting surgical candidates. We describe the surgical options for resective epilepsy surgery in TLE and its commonly associated risks while highlighting some of the controversies. Lastly, we present teaching cases to illustrate the presurgical workup of patients with medically refractory TLE.

scholarly journals Use of Cerebrovascular Reactivity in Patients with Symptomatic Major Cerebral Artery Occlusion to Predict 5-Year Outcome: Comparison of Xenon-133 and Iodine-123-IMP Single-Photon Emission Computed Tomography

2002 ◽  
Vol 22 (9) ◽  
pp. 1142-1148 ◽  
Author(s):  
Kuniaki Ogasawara ◽  
Akira Ogawa ◽  
Kazunori Terasaki ◽  
Hiroaki Shimizu ◽  
Teiji Tominaga ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Single Photon ◽  
Independent Predictor ◽  
Photon Emission ◽  
Survival Rates ◽  
Artery Occlusion ◽  
Cerebrovascular Reactivity ◽  
Emission Computed Tomography ◽  
Percent Change ◽  
Cerebral Artery Occlusion

The aim of this prospective study was to investigate whether decreased cerebrovascular reactivity to acetazolamide, as determined by single-photon emission computed tomography (SPECT), is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion. Cerebrovascular reactivity to acetazolamide in the middle cerebral artery (MCA) territory ipsilateral to the occluded artery was determined on the basis of two different methodologies: cerebral blood flow (CBF) percent change obtained quantitatively from xenon-133 (133Xe) SPECT, and asymmetry index (AI) percent change obtained qualitatively from N-isopropyl- p-[123I]-iodoamphetamine (IMP) SPECT. Seventy patients with unilateral internal carotid artery or MCA occlusion were divided into two groups within each SPECT methodology (normal or decreased CBF percent change and AI percent change) and followed up for 5 years. Cumulative recurrence-free survival rates for patients with decreased CBF percent change were significantly lower than for those with normal CBF percent change ( P = 0.0205). There was no significant difference in cumulative recurrence-free survival rates between patients with decreased AI percent change and those with normal AI percent change. Only decreased CBF percent change was a significant independent predictor of stroke recurrence ( P = 0.0051). The present study demonstrated that decreased cerebrovascular reactivity to acetazolamide determined quantitatively by Xe SPECT is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion, and that the qualitative method using I-IMP SPECT is a poor predictor of the risk of subsequent stroke in this type of patient.

scholarly journals Splenosis Mimicking Peritoneal Seeding of Advanced Colon Cancer Can Be Identified by Spleen SPECT/CT and FDG PET/CT

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1045
Author(s):  
Ji Young Lee ◽  
Hee-Sung Song ◽  
Jimin Han
Keyword(s):  
Computed Tomography ◽  
Colon Cancer ◽  
Fdg Pet ◽  
Treatment Plan ◽  
Photon Emission ◽  
Hepatic Metastases ◽  
Emission Computed Tomography ◽  
Peritoneal Seeding ◽  
Pet Ct ◽  
Fdg Pet Ct

This case report demonstrates that Tc-99m labeled heat-damaged red blood cell single-photon emission computed tomography/computed tomography (spleen SPECT/CT) and F-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) could noninvasively confirm splenosis mimicking peritoneal seeding of advanced sigmoid colon cancer with hepatic metastases, and played a crucial role in determining the treatment plan.

scholarly journals Case report of an elderly woman with atypical imaging for primary central nervous system lymphoma who needed a brain biopsy for diagnosis

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110351
Author(s):  
Kosuke Matsuzono ◽  
Tomoya Yagisawa ◽  
Keisuke Ohtani ◽  
Yohei Ishishita ◽  
Takashi Yamaguchi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fdg Pet ◽  
Single Photon ◽  
Photon Emission ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Emission Computed Tomography ◽  
Stereotactic Brain Biopsy ◽  
Imaging Results

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma, but its diagnosis is challenging in some cases. A brain biopsy is the gold standard for diagnosing PCNSL, but its invasiveness can be problematic. Thus, noninvasive imaging examinations have been developed for the pre-surgical diagnosis of PCNSL, including gadolinium-enhanced magnetic resonance imaging (MRI), 123I-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT), and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET). Here, we report the case of a 71-year-old woman with negative imaging findings for PCNSL, but who was diagnosed with PCNSL by a brain biopsy and histological analysis. Her imaging results were negative for gadolinium-enhanced cranial MRI, with low uptake in 123I-IMP SPECT and hypometabolism in 18F-FDG PET. However, a stereotactic brain biopsy from an abnormal lesion revealed that many round cells had infiltrated into the brain. Moreover, many infiltrating cells were positive for cluster of differentiation (CD)20 and CD79a, and proliferation marker protein Ki-67-positive cells accounted for nearly 80% of all cells. Based on these results, our final pathological diagnosis was PCNSL. The present case highlights the possibility of a PCNSL diagnosis even when all imaging-related examinations display negative results.

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