Focal motor seizures with secondary generalization arising in the cerebellum

2002 ◽  
Vol 97 (1) ◽  
pp. 190-196 ◽  
Author(s):  
Ali H. Mesiwala ◽  
John D. Kuratani ◽  
Anthony M. Avellino ◽  
Theodore S. Roberts ◽  
Marcio A. Sotero ◽  
...  
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Cerebellar Hemisphere ◽  
Dysplastic Lesion ◽  
Content Type ◽  
Depth Electrodes ◽  
Left Cerebellar Hemisphere ◽  
Eeg Recordings ◽  
Cerebellar Mass ◽  
Secondary Generalization

✓ The issue of whether seizures can arise in the cerebellum remains controversial. The authors present the first known case of focal subcortical epilepsy with secondary generalization thought to arise from a dysplastic lesion within the cerebellum. A newborn infant presented with daily episodes of left eye blinking, stereotyped extremity movements, postural arching, and intermittent altered consciousness lasting less than 1 minute. These episodes began on his 1st day of life and progressively increased in frequency to more than 100 events per day. Antiepileptic medications had no effect, and interictal and ictal scalp electroencephalography (EEG) recordings demonstrated bilateral electrical abnormalities. Magnetic resonance imaging revealed a mass in the left cerebellar hemisphere, and ictal and interictal single-photon emission computerized tomography revealed a focal perfusion abnormality in the region of the cerebellar mass. The patient subsequently underwent intraoperative EEG monitoring with cortical scalp electrodes and cerebellar depth electrodes. Intraoperative EEG recordings revealed focal seizure discharges that arose in the region of the cerebellar mass and influenced electrographic activity in both cerebral hemispheres. Resection of this mass and the left cerebellar hemisphere led to complete resolution of the patient's seizures and normalization of the scalp EEG readings. Neuropathological findings in this mass were consistent with ganglioglioma. A review of the literature on the cerebellar origins of epilepsy is included.

Dual-isotope single-photon emission computerized tomography scanning in patients with glioblastoma multiforme: association with patient survival and histopathological characteristics of tumor after high-dose radiotherapy

1998 ◽  
Vol 89 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Richard B. Schwartz ◽  
B. Leonard Holman ◽  
Joseph F. Polak ◽  
Basem M. Garada ◽  
Marc S. Schwartz ◽  
...  
Keyword(s):  
Survival Rate ◽  
Glioblastoma Multiforme ◽  
Single Photon ◽  
Photon Emission ◽  
High Dose ◽  
Term Survival ◽  
Content Type ◽  
Dual Isotope ◽  
Fine Print

Object. The study was conducted to determine the association between dual-isotope single-photon emission computerized tomography (SPECT) scanning and histopathological findings of tumor recurrence and survival in patients treated with high-dose radiotherapy for glioblastoma multiforme. Methods. Studies in which SPECT with 201Tl and 99mTc-hexamethypropyleneamine oxime (HMPAO) were used were performed 1 day before reoperation in 47 patients with glioblastoma multiforme who had previously been treated by surgery and high-dose radiotherapy. Maximum uptake of 201Tl in the lesion was expressed as a ratio to that in the contralateral scalp, and uptake of 99mTc-HMPAO was expressed as a ratio to that in the cerebellar cortex. Patients were stratified into groups based on the maximum radioisotope uptake values in their tumor beds. The significance of differences in patient gender, histological characteristics of tissue at reoperation, and SPECT uptake group with respect to 1-year survival was elucidated by using the chi-square statistic. Comparisons of patient ages and time to tumor recurrence as functions of 1-year survival were made using the t-test. Survival data at 1 year were presented according to the Kaplan—Meier method, and the significance of potential differences was evaluated using the log-rank method. The effects of different variables (tumor type, time to recurrence, and SPECT grouping) on long-term survival were evaluated using Cox proportional models that controlled for age and gender. All patients in Group I (201Tl ratio < 2 and 99mTc-HMPAO ratio < 0.5) showed radiation changes in their biopsy specimens: they had an 83.3% 1-year survival rate. Group II patients (201T1 ratio < 2 and 99mTc-HMPAO ratio of ≥ 0.5 or 201Tl ratio between 2 and 3.5 regardless of 99mTc-HMPAO ratio) had predominantly infiltrating tumor (66.6%); they had a 29.2% 1-year survival rate. Almost all of the patients in Group III (201Tl ratio > 3.5 and 99mTc-HMPAO ratio ≥ 0.5) had solid tumor (88.2%) and they had a 6.7% 1-year survival rate. Histological data were associated with 1-year survival (p < 0.01); however, SPECT grouping was more closely associated with 1-year survival (p < 0.001) and was the only variable significantly associated with long-term survival (p < 0.005). Conclusions. Dual-isotope SPECT data correlate with histopathological findings made at reoperation and with survival in patients with malignant gliomas after surgical and high-dose radiation therapy.

Utility of indocyanine green in the detection of radiologically silent hemangioblastomas: case report

2021 ◽  
pp. 1-7
Author(s):  
Alice Senta Ryba ◽  
Juan Sales-Llopis ◽  
Stefan Wolfsberger ◽  
Aki Laakso ◽  
Roy Thomas Daniel ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Histological Analysis ◽  
Complete Resection ◽  
Fluorescent Imaging ◽  
Cerebellar Hemisphere ◽  
Potential Applications ◽  
Left Cerebellar Hemisphere ◽  
Future Treatments ◽  
Cerebellar Mass ◽  
Suboccipital Approach

Hemangioblastomas (HBs) are rare, benign, hypervascularized tumors. Fluorescent imaging with indocyanine green (ICG) can visualize tumor angioarchitecture. The authors report a case of multiple HBs involving two radiologically silent lesions only detected intraoperatively by ICG fluorescence. A 26-year-old woman presented with a cystic cerebellar mass on the tentorial surface of the left cerebellar hemisphere on MRI. A left paramedian suboccipital approach was performed to remove the mural nodule with the aid of ICG injection. The first injection, applied just prior to removing the nodule, highlighted the tumor and vessels. After resection, two new lesions, invisible on the preoperative MRI, surprisingly enhanced on fluorescent imaging 35 minutes after the ICG bolus. Both silent lesions were removed. Histological analysis of all three lesions revealed they were positive for HB. The main goal of this report is to hypothesize possible explanations about the mechanism that led to the behavior of the two silent lesions. Intraoperative ICG videoangiography was useful to understand the 3D angioarchitecture and HB flow patterns to perform a safe and complete resection in this case. Understanding the HB ultrastructure and pathophysiological mechanisms, in conjunction with the properties of ICG, may expand potential applications for their diagnosis and future treatments.

Diagnostic value of 201Tl—single-photon emission computerized tomography studies in cases of posterior fossa hemangioblastomas

2001 ◽  
Vol 95 (2) ◽  
pp. 292-297 ◽  
Author(s):  
Takeo Kondo ◽  
Toshihiro Kumabe ◽  
Shin Maruoka ◽  
Takashi Yoshimoto
Keyword(s):  
Computerized Tomography ◽  
Posterior Fossa ◽  
Single Photon ◽  
Photon Emission ◽  
Magnetic Resonance Images ◽  
Thallium 201 ◽  
Homologous Region ◽  
Single Photon Emission ◽  
Content Type ◽  
Fine Print

Object. The 201Tl uptake index was evaluated for its usefulness in formulating a diagnosis of hemangioblastoma. Thallium-201—single-photon emission computerized tomography (SPECT) studies were performed in nine patients harboring hemangioblastomas in the posterior fossa and in five patients (six lesions) with gliomas in the posterior fossa. Methods. The 201Tl uptake index was defined as the ratio of mean counts of isotope per pixel in the tumor to mean counts of isotope per pixel in the homologous region of the healthy brain. The 201Tl uptake indices of the early image (TlE) and that of the delayed image (TlD) were calculated. The isotope retention index (RI) was calculated as (TlE − TlD)/TlE. The TlE was 2.7 ± 0.7 in hemangioblastomas and 2.9 ± 1.7 in gliomas (mean ± standard deviation). The TlD was 1.5 ± 0.4 in hemangioblastomas and 2.4 ± 1.6 in gliomas. There were no significant differences between hemangioblastomas and gliomas when TlEs and TlDs were compared. The isotope RI was 0.43 ± 0.07 in hemangioblastomas and 0.15 ± 0.1 in gliomas, showing a significantly higher RI in hemangioblastomas compared with gliomas (p < 0.01). Conclusions. Thallium-201 washout is significantly faster in hemangioblastomas. Hemangioblastoma is biologically benign, but contains a rich capillary network that forms a hypervascular tumor bed. Variations in its appearance on magnetic resonance images may cause difficulties in the differential diagnosis of hemangioblastoma. Thallium-201 SPECT studies can be used to distinguish hemangioblastomas from gliomas in the posterior fossa.

Severe symptomatic vasospasm: the role of immediate postoperative angioplasty

1994 ◽  
Vol 80 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Peter D. le Roux ◽  
David W. Newell ◽  
Joseph Eskridge ◽  
Marc R. Mayberg ◽  
H. Richard Winn
Keyword(s):  
Clinical Presentation ◽  
Single Photon ◽  
Clinical Success ◽  
Photon Emission ◽  
Transcranial Doppler Ultrasound ◽  
Single Photon Emission ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Symptomatic Vasospasm

✓ The clinical success of angioplasty for symptomatic vasospasm following subarachnoid hemorrhage (SAH) depends on early intervention and can best be achieved after the aneurysm is occluded. However, patients presenting with unsecured ruptured aneurysms and established clinical vasospasm offer a dilemma for the surgeon. The authors describe the cases of five such patients who underwent acute clipping of aneurysms followed by immediate postoperative angioplasty between 1988 and 1992. All were referred at least 5 days after SAH. Severe vasospasm compatible with the clinical presentation was confirmed by angiography. The patients met the department's criteria for angioplasty but, because of unclipped aneurysms, were first taken to the operating room for a craniotomy and aneurysm obliteration. Angiography was repeated immediately after surgery. Arterial narrowing had progressed during surgery in two patients. In all patients, postoperative mechanical dilatation was achieved with the use of a silicone microballoon. Following angioplasty, transcranial Doppler ultrasound flow velocities and single-photon emission computerized tomography evaluation indicated improved cerebral perfusion compared to preoperative determinations. Four patients improved clinically and made a good recovery. In this subgroup of patients presenting with proven symptomatic vasospasm and an unclipped but ruptured aneurysm, urgent surgical obliteration of the aneurysm followed by immediate postoperative angioplasty may be a safe and reasonable means to improve outcome.

Venous ischemia caused by dural arteriovenous malformation

1994 ◽  
Vol 80 (3) ◽  
pp. 552-555 ◽  
Author(s):  
Akira Kurata ◽  
Yoshio Miyasaka ◽  
Takatomo Yoshida ◽  
Masatake Kunh ◽  
Kenzoh Yada ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Single Photon ◽  
Photon Emission ◽  
Occipital Lobe ◽  
Ct Scans ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
Ischemic Region ◽  
Ischemic Change ◽  
The Right

✓ A case is presented of tentorial dural arteriovenous malformation (AVM) associated with visual hallucinations and quadrant hemianopsia. Computerized tomography (CT) and magnetic resonance imaging showed an ischemic region, mainly affecting the white matter of the right occipital lobe, that was defined as an area of increased blood volume on dynamic CT scans and as a decrease in cerebral blood flow on N-isopropylp-123I-iodoamphetamine single-photon emission CT scans. Angiography demonstrated venous congestion, probably because the retrograde arterial inflow from the dural AVM into the corticomedullary vein was direct and not via the sinuses. The symptoms and radiological findings improved immediately after endovascular treatment. The origin of these symptoms was fully evaluated and confirmed to be a reversible ischemic change caused by disturbance of the volume of venous return over an extensive area.

Monitoring of 57Co-bleomycin delivery to brain metastases and their tumors of origin

1987 ◽  
Vol 67 (4) ◽  
pp. 506-510 ◽  
Author(s):  
Dov Front ◽  
Einat Even-Sapir ◽  
Galina Iosilevsky ◽  
Ora Israel ◽  
Alex Frenkel ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Lung Tumor ◽  
Single Photon ◽  
Photon Emission ◽  
Lung Tumors ◽  
Drug Uptake ◽  
Content Type ◽  
Significant Difference ◽  
The Difference ◽  
The Brain

✓ The concentration of cobalt-57 (57Co)-labeled bleomycin delivered to three brain metastases and to their tumors of origin in the lungs was measured using a single-photon emission computerized tomography technique. In two brain metastases the 57Co-bleomycin concentration measured at different times after the intravenous injection was significantly lower than that in the originating lung tumors (p < 0.01 and p < 0.001). In these two patients, the tumor cumulative concentration (TCC) of drug in the brain neoplasm compared to the lung carcinoma was 12.92 versus 15.12 and 10.30 versus 19.74 µg/cc/min. In the third patient there was no significant difference in drug concentration between the tumor in the brain and in the lung (TCC 16.02 vs. 15.09 µg/cc/min). There was a significant difference in the drug TCC between the three brain metastases: the difference between the lowest and highest concentrations was more than 50% (10.3 vs. 16.02 µg/cc/min). When the concentration in the tumor over time (CT(t)) of the 57Co-bleomycin was compared in the brain and lung tumors, a good correlation was found in each of the three cases (r = 0.93, 0.99, and 0.97). This suggests that the difference in drug uptake between brain metastases and their originating lung tumor is a quantitative rather than a qualitative phenomenon. The results show that the amount of drug to which brain metastases are exposed varies and may be very low in some tumors; therefore, effectiveness of drug delivery may play a role in the nonresponsiveness of brain metastases to treatment.

Development of cerebellar malignant astrocytoma at site of a medulloblastoma treated 11 years earlier

1978 ◽  
Vol 49 (3) ◽  
pp. 445-449 ◽  
Author(s):  
Enrique Klériga ◽  
Joanna Hollenberg Sher ◽  
Sanath-Kumar Nallainathan ◽  
Sherman C. Stein ◽  
Michael Sacher
Keyword(s):  
Cerebellar Hemisphere ◽  
Malignant Astrocytoma ◽  
Content Type ◽  
Left Cerebellar Hemisphere ◽  
Desmoplastic Medulloblastoma ◽  
Second Tumor ◽  
Fine Print

✓ A child treated for a desmoplastic medulloblastoma of the left cerebellar hemisphere at the age of 10 months developed a malignant astrocytoma in the same site 11 years later. Theories of origin of the second tumor, particularly in relation to concepts of the genesis of medulloblastoma in general, are discussed.

Focal cerebral hyperemia after focal head injury in humans: a benign phenomenon?

1995 ◽  
Vol 83 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Damianos E. Sakas ◽  
M. Ross Bullock ◽  
James Patterson ◽  
Donald Hadley ◽  
David J. Wyper ◽  
...  
Keyword(s):  
Head Injury ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Injury Severity ◽  
Single Photon ◽  
Wide Spectrum ◽  
Photon Emission ◽  
Normal Brain ◽  
Content Type ◽  
Fine Print

✓ To assess the relationship between posttraumatic cerebral hyperemia and focal cerebral damage, the authors performed cerebral blood flow mapping studies by single-photon emission computerized tomography (SPECT) in 53 patients within 3 weeks of brain injury. Focal zones of hyperemia were present in 38% of patients. Hyperemia was correlated with clinical features and early computerized tomography (CT) and magnetic resonance (MR) imaging performed within 48 hours of the SPECT study and late CT and MR studies at 3 months. The hyperemia was observed primarily in structurally normal brain tissue (both gray and white matter), as revealed by CT and MR imaging, immediately adjacent to intraparenchymal or extracerebral focal lesions; it persisted for up to 10 days, but was never seen within the edematous pericontusional zones. The percentage of patients in the hyperemic group having brief (< 30 minutes) or no loss of consciousness was significantly higher than in the nonhyperemic group (twice as high, p < 0.05). Other clinical parameters were not significantly more common in the hyperemic group. The mortality of patients with focal hyperemia was lower than that of individuals without it, and the outcome of survivors with hyperemia was slightly better than patients without hyperemia. These results differ from the literature, which suggests that global posttraumatic hyperemia is primarily an acute, malignant phenomenon associated with increased intracranial pressure, profound unconsciousness, and poor outcome. The current results agree with more recent studies which show that posttraumatic hyperemia may occur across a wide spectrum of head injury severity and may be associated with favorable outcome.

scholarly journals SPECT Imaging of Epilepsy: An Overview and Comparison with F-18 FDG PET

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Sunhee Kim ◽  
James M. Mountz
Keyword(s):  
Fdg Pet ◽  
Functional Neuroimaging ◽  
Single Photon ◽  
Photon Emission ◽  
Imaging Modalities ◽  
Emission Computed Tomography ◽  
Functional Changes ◽  
Analysis Methods ◽  
Positron Emission ◽  
Eeg Recordings

Epilepsy surgery is highly effective in treating refractory epilepsy, but requires accurate presurgical localization of the epileptogenic focus. Briefly, localization of the region of seizure onset traditionally dependents on seizure semiology, scalp EEG recordings and correlation with anatomical imaging modalities such as MRI. The introduction of noninvasive functional neuroimaging methods, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET) has dramatically changed the method for presurgical epilepsy evaluation. These imaging modalities have become powerful tools for the investigation of brain function and are an essential part of the evaluation of epileptic patients. Of these methods, SPECT has the practical capacity to image blood flow functional changes that occur during seizures in the routine clinical setting. In this review we present the basic principles of epilepsy SPECT and PET imaging. We discuss the properties of the SPECT tracers to be used for this purpose and imaging acquisition protocols as well as the diagnostic performance of SPECT in addition to SPECT image analysis methods. This is followed by a discussion and comparison to F-18 FDG PET acquisition and imaging analysis methods.

scholarly journals Radioiodinated DPA-713 Imaging Correlates with Bactericidal Activity of Tuberculosis Treatments in Mice

2014 ◽  
Vol 59 (1) ◽  
pp. 642-649 ◽  
Author(s):  
Alvaro A. Ordonez ◽  
Supriya Pokkali ◽  
Vincent P. DeMarco ◽  
Mariah Klunk ◽  
Ronnie C. Mease ◽  
...  
Keyword(s):  
Single Photon ◽  
Ex Vivo ◽  
Photon Emission ◽  
Drug Regimen ◽  
Imaging Biomarker ◽  
Emission Computed Tomography ◽  
Necrosis Factor Alpha ◽  
Content Type ◽  
Highly Active ◽  
Tnf Α

ABSTRACTCurrent tools for monitoring response to tuberculosis treatments have several limitations. Noninvasive biomarkers could accelerate tuberculosis drug development and clinical studies, but to date little progress has been made in developing new imaging technologies for this application. In this study, we developed pulmonary single-photon emission computed tomography (SPECT) using radioiodinated DPA-713 to serially monitor the activity of tuberculosis treatments in live mice, which develop necrotic granulomas and cavitary lesions. C3HeB/FeJ mice were aerosol infected withMycobacterium tuberculosisand administered either a standard or a highly active bedaquiline-containing drug regimen. Serial125I-DPA-713 SPECT imaging was compared with18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and standard microbiology.Ex vivostudies were performed to characterize and correlate DPA-713 imaging with cellular and cytokine responses. Pulmonary125I-DPA-713 SPECT, but not18F-FDG PET, was able to correctly identify the bactericidal activities of the two tuberculosis treatments as early as 4 weeks after the start of treatment (P< 0.03). DPA-713 readily penetrated the fibrotic rims of necrotic and cavitary lesions. A time-dependent decrease in both tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) levels was observed with treatments, with125I-DPA-713 SPECT correlating best with tissue TNF-α levels (ρ = 0.94;P< 0.01).124I-DPA-713 was also evaluated as a PET probe and demonstrated a 4.0-fold-higher signal intensity in the infected tuberculous lesions than uninfected controls (P= 0.03). These studies provide proof of concept for application of a novel noninvasive imaging biomarker to monitor tuberculosis treatments, with the potential for application for humans.

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