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.

Stratifying drug treatment of cognitive impairments after traumatic brain injury using neuroimaging

Brain ◽  
2019 ◽  
Vol 142 (8) ◽  
pp. 2367-2379 ◽  
Author(s):  
Peter O Jenkins ◽  
Sara De Simoni ◽  
Niall J Bourke ◽  
Jessica Fleminger ◽  
Gregory Scott ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Reaction Time ◽  
Dopamine Transporter ◽  
Choice Reaction Time ◽  
Cognitive Impairments ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Dopaminergic Drugs ◽  
Median Change

Abstract Cognitive impairment is common following traumatic brain injury. Dopaminergic drugs can enhance cognition after traumatic brain injury, but individual responses are highly variable. This may be due to variability in dopaminergic damage between patients. We investigate whether measuring dopamine transporter levels using 123I-ioflupane single-photon emission computed tomography (SPECT) predicts response to methylphenidate, a stimulant with dopaminergic effects. Forty patients with moderate-severe traumatic brain injury and cognitive impairments completed a randomized, double-blind, placebo-controlled, crossover study. 123I-ioflupane SPECT, MRI and neuropsychological testing were performed. Patients received 0.3 mg/kg of methylphenidate or placebo twice a day in 2-week blocks. Subjects received neuropsychological assessment after each block and completed daily home cognitive testing during the trial. The primary outcome measure was change in choice reaction time produced by methylphenidate and its relationship to stratification of patients into groups with normal and low dopamine transporter binding in the caudate. Overall, traumatic brain injury patients showed slow information processing speed. Patients with low caudate dopamine transporter binding showed improvement in response times with methylphenidate compared to placebo [median change = −16 ms; 95% confidence interval (CI): −28 to −3 ms; P = 0.02]. This represents a 27% improvement in the slowing produced by traumatic brain injury. Patients with normal dopamine transporter binding did not improve. Daily home-based choice reaction time results supported this: the low dopamine transporter group improved (median change −19 ms; 95% CI: −23 to −7 ms; P = 0.002) with no change in the normal dopamine transporter group (P = 0.50). The low dopamine transporter group also improved on self-reported and caregiver apathy assessments (P = 0.03 and P = 0.02, respectively). Both groups reported improvements in fatigue (P = 0.03 and P = 0.007). The cognitive effects of methylphenidate after traumatic brain injury were only seen in patients with low caudate dopamine transporter levels. This shows that identifying patients with a hypodopaminergic state after traumatic brain injury can help stratify the choice of cognitive enhancing therapy.

scholarly journals Impact of 18F-FDG PET scan on the prevalence of benign thoracic lesions at surgical resection

2011 ◽  
Vol 44 (5) ◽  
pp. 279-282 ◽  
Author(s):  
Kamlesh Mohan ◽  
James McShane ◽  
Richard Page ◽  
Klaus Irion ◽  
Martin J. Ledson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Surgical Resection ◽  
False Positive ◽  
Fdg Pet ◽  
Pet Scan ◽  
Benign Lesions ◽  
Group I ◽  
Pet Scanning ◽  
Fdg Pet Scan ◽  
Group Ii

OBJECTIVE: The main utility of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) lies in the staging of lung cancer. However, it can also be used to differentiate indeterminate pulmonary lesions, but its impact on the resection of benign lesions at surgery is unknown. The aim of this study was to compare the prevalence of benign lesions at thoracotomy carried out for suspected lung cancer, before and after the introduction of PET scanning in a large thoracic surgical centre. MATERIALS AND METHODS: We reviewed our prospectively recorded surgical database for all consecutive patients undergoing thoracotomy for suspected or proven lung cancer and compared the prevalence of benign lesions in 2 consecutive 2-year groups, before (group I) and after (group II) the introduction of FDG-PET scan respectively. RESULTS: Surgical resection was performed on 1233 patients during the study period. The prevalence of benign lesions at surgery in groups I and II was similar (44/626 and 41/607, both 7%), and also in group II between those who underwent FDG-PET scan and the remainder (21/301 and 20/306 respectively, both 7%). In group II, of the 21 patients with benign lesions, who underwent FDG-PET, 19 had a false positive scan (mean standardised uptake value 5.3 [range 2.6-12.7]). Of these, 13 and 4 patients respectively had non-diagnostic bronchoscopy and percutaneous transthoracic lung biopsy pre thoracotomy. There was no difference in the proportion of different benign lesions resected between group I and those with FDG-PET in group II. CONCLUSION: The introduction of FDG-PET scanning has not altered the proportion of patients undergoing thoracotomy for ultimately benign lesions, mainly due to the avidity for the isotope of some non-malignant lesions. Such false positive results need to be considered when patients with unconfirmed lung cancer are contemplated for surgical resection.

scholarly journals PET Scanning in Partial Epilepsy

1991 ◽  
Vol 18 (S4) ◽  
pp. 588-592 ◽  
Author(s):  
Jerome Engel
Keyword(s):  
Fdg Pet ◽  
Single Photon ◽  
Photon Emission ◽  
Biologically Active ◽  
Emission Computed Tomography ◽  
Supporting Evidence ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Positron Emission ◽  
Pet Scanning

ABSTRACT:Many biologically active tracers are available for positron emission tomography (PET) investigations, but most studies of epilepsy have utilized l8F-fluorodeoxyglucose (FDG) to measure local cerebral metabolic rate for glucose. Over 70% of patients with medically refractory partial seizures demonstrate an interictal zone of hypometabolism corresponding to the epileptogenic region. This metabolic defect commonly involves the temporal lobe in patients with complex partial seizures of mesial temporal origin, and is encountered less consistently with seizures of extratemporal neocortical origin. Although false localization is less likely with FDG-PET than with EEG, the hypometabolic zone merely reflects a focal functional deficit and its epileptogenicity must still be demonstrated electrophysiologically. When hemispherectomy or large multilobar resections are planned in small children, FDG-PET also provides useful supporting evidence that the contralateral hemisphere is functioning normally. It is difficult to obtain FDG-PET scans and to interpret results during spontaneous partial seizures. Ictal scans can be more easily obtained with single photon emission computed tomography (SPECT), which may provide information for planning surgical resections.

scholarly journals Role of Hyperbaric Oxygen Therapy in Traumatic Brain Injury—Evidence-Based Consensus

2020 ◽  
Vol 17 (01) ◽  
pp. 42-45
Author(s):  
Vernon Velho ◽  
Hrushikesh Kharosekar ◽  
Laxmikant Bhople ◽  
Deepak A. Palande
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Photon Emission ◽  
Treatment Modalities ◽  
Emission Computed Tomography ◽  
Major Health Problem

AbstractTraumatic brain injury (TBI) is a major health problem in India and worldwide, resulting in significant morbidity, mortality, and disabilities of young and productive group of society. Various treatment modalities in the immediate period following a TBI are focused on altering the acute pathophysiology. Secondary injury is precipitated by ischemia resulting from decreased cerebral blood flow leading to hypoxia and is particularly likely to occur in the first 24 hours after injury. Hyperbaric oxygen therapy (HBOT) targets TBI-induced ischemia by exposing patients to an environment that substantially increases the amount of O2 inspiration (100% O2 at >1 atmosphere absolute), producing an increased O2 concentration in the plasma and thus increased delivery of O2 for diffusion to brain tissue. Despite the capacity of HBOT to protect against secondary ischemic damage, the use of HBOT for the treatment of TBI has been controversial. To gain acceptance in routine clinical use, a clinical method of assessing its effectiveness in the individual patient, computed tomography perfusion scan, single-photon emission computed tomography scans, and other intermediate indicators of the effects of HBOT should be examined by large and high-quality studies.

NEUROPSYCHOLOGICAL CHANGES IN PATIENTS WITH A CONSEQUENCE OF TRAUMATIC BRAIN INJURY

2020 ◽  
Vol 3 (1) ◽  
pp. 44-46
Author(s):  
Istatillo Shodjalilov ◽  
◽  
Saoda Igamova ◽  
Aziza Djurabekova
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Neuropsychological Testing ◽  
Anxiety And Depression ◽  
Psychopathological Symptoms ◽  
Neuropsychological Changes ◽  
The Relationship

The incidence of cognitive impairment in TBI is high, depending on the severity. At the same time, psychopathological symptoms in the form of asthenia, increased anxiety and depression are encountered among patients with TBI. The work studied the relationship between cognitive and psychopathological symptoms in patients with TBI using neuropsychological testing on scales.

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