We report a 61-year-old right-handed man developing disturbance of memory after a discrete thalamic infarction. Neuropsychological assessment revealed deficits in memory with retrograde and anterograde components, especially for verbal material. Brain MRI showed a left anterior thalamic infarction with normal angiographic findings. Despite the small lesion in the thalamus, he showed prolonged memory disturbance and a Brain SPECT image revealed decreased uptake in the ipsilateral fronto-temporo-parietal cortex and contralateral cerebellum. This diaschisis, a phenomenon caused by disconnection of the neural pathway helped us to evaluate the functional state of the patient and this imaging technique was valuable for obtaining to get more information for the evaluation of the neurological state and neuronal connections. In conclusion our findings correspond well with the understanding of amnesia as a disconnection syndrome because of the evidence of diaschisis on the Brain SPECT image.
Amnesia/*etiology ; Brain/*radionuclide imaging ; Case Report ; Cerebellum/radionuclide imaging ; Cerebral Infarction/*complications/radionuclide imaging ; Human ; Male ; Middle Age ; Thalamic Diseases/*complications/radionuclide imaging ; *Tomography, Emission-Computed, Single-Photon

The six patients included in this study had painful dysesthesia, resulting from vascular lesions in or near the thalamus, confirmed by computerized tomography(CT) brain scan. Using hexamethyl propyleneamine oxime(HM-PAO) single photon emission computed tomography(SPECT) brain scanning, regional cerebral perfusion(rCP) was demonstrated. In contrast to three patients with lesions near the thalamus who showed symmetrical cortical radioactivity, the other three patients with thalamic lesions revealed decreased rCP in the ipsilateral cerebral cortex on HM-PAO brain SPECT. We thought that the loss of afferent activating stimuli from the thalamus led to decreased cortical neuronal activity and the following hypoperfusion. In patients with thalamic syndrome resulting from thalamic lesions, the role of the remote effect of the thalamic damage and consequent cortical deregulation in the development of thalamic pain and/or neuropsychological symptoms cannot be excluded completely.
Brain/*radionuclide imaging ; Female ; Human ; Male ; Middle Age ; Organotechnetium Compounds ; Oximes ; Pain/etiology ; Syndrome ; Technetium/diagnostic use ; Technetium Tc 99m Exametazime ; Thalamic Diseases/*radionuclide imaging ; Tomography, Emission-Computed, Single-Photon

We used single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (99mTc-HM-PAO) in 14 studies on 6 patients with delayed neurologic sequelae from carbon monoxide (CO) poisoning to determine whether any changes in cerebral blood flow could be correlated with clinical or computed tomographic evidence of delayed deficits. Among the six initial CT brain scans, two showed low density of both basal ganglia and two showed decreased density of the cerebral white matter. There was no correlation between the clinical outcome and the findings of the follow-up CT brain scans. Of the two SPECTS with 99mTc-HM-PAO performed during acute anoxic insult, one showed focal hypoperfusion which appeared 20 days prior to the onset of delayed neurologic sequelae after CO poisoning. Seven SPECTs in the six patients performing the delayed phase showed diffuse patched patterns of hypoperfusion which improved on follow-up images. There was good correlation between the clinical outcome and the findings of the 99mTc-HM-PAO SPECT. In preliminary conclusion, 9Tc-HM-PAO brain SPECT can be used for predicting or evaluating the outcome of delayed neurologic sequelae after CO poisoning. Cerebral vascular changes may be the possible cause of hypoperfusion in patients with CO poisoning.
Adult ; Aged ; Brain Diseases/etiology/*radionuclide imaging ; Carbon Monoxide Poisoning/*complications ; Female ; Humans ; Middle Aged ; Organotechnetium Compounds/*diagnostic use ; Oximes/*diagnostic use ; Predictive Value of Tests ; Technetium Tc 99m Exametazime ; Time Factors ; *Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. METHODS: Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (> or = 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. RESULTS: A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NT-proBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. CONCLUSIONS: Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.
Aged ; Biological Markers/blood ; Chi-Square Distribution ; Female ; Heart Diseases/blood/*etiology/mortality ; Heart Failure/etiology ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/etiology ; Natriuretic Peptide, Brain/*blood ; Odds Ratio ; Peptide Fragments/*blood ; Predictive Value of Tests ; Preoperative Period ; Prospective Studies ; ROC Curve ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Surgical Procedures, Elective ; Time Factors ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome ; Vascular Diseases/blood/mortality/radionuclide imaging/*surgery ; Vascular Surgical Procedures/*adverse effects/mortality