“Luxury perfusion” with99mTc-HMPAO and123I-IMP SPECT imaging during the subacute phase of stroke

Jl, Moretti; Defer, Gilles; Cinotti, L.; Césaro, P.; Jd, Degos; Vigneron, N; Ducassou, D.; Bl, Holman

doi:10.1007/bf01566007

Cited by 61 publications

(25 citation statements)

References 20 publications

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“…Flow compensation to restore perfusion in still viable perilesional cerebral tissue on the affected side (i.e. the ‘luxury’ perfusion) might explain the higher MCA MFV observed in our study on ICH patients, as previously described for functional neuroimaging in penumbral areas, but during acute and subacute ischemic stroke [19,20,21,22]. The higher blood flow velocities previously observed in the affected ischemic hemisphere were identified by means of TCD ultrasonography and represent the well-known Zanette asymmetry index, due to MCA recanalization and intracerebral reperfusion [23,24], but we might hypothesize that there are still suffering cerebral areas surrounding the hematoma requiring hyperperfusion.…”

Section: Discussionsupporting

confidence: 60%

Effects of a Single Mannitol Bolus on Cerebral Hemodynamics in Intracerebral Hemorrhage: A Transcranial Doppler Study

Vicenzini

Ricciardi²,

Zuco

et al. 2011

Cerebrovasc Dis

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Background: Mannitol infusion is widely used in clinical practice to reduce perilesional edema in intracerebral hemorrhage (ICH), though no controlled studies have yet provided evidence of its effects on clinical outcome or on cerebral blood flow impairment following the event. The aim of our study was to evaluate blood flow velocity changes in the middle cerebral arteries (MCA) after a mannitol bolus in patients with ICH. Methods: Transcranial Doppler bilateral monitoring was performed for 90 min in 20 patients with ICH, during 100 ml mannitol bolus i.v. administration. The MCA mean flow velocities (MFVs) and pulsatility index (PI) were recorded. Results: When the ‘healthy’ and the ‘affected’ hemispheres were compared, we observed higher MCA MFV and lower PI on the affected side than on the contralateral side, both at baseline and during the experiment. After the mannitol bolus, we observed a significant MFV increase, starting at the end of the infusion and lasting longer than 60 min in the MCA on the affected side alone. The PI increased after mannitol administration on the healthy side alone. Conclusions: A single bolus of mannitol modified cerebral hemodynamics in our patients with ICH, increasing flow velocities on the affected MCA. This effect may be a consequence of reduced edema in the perilesional areas. The increased PI on the unaffected side may be indicative of preserved pulsatility in the healthy hemisphere.

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Section: Discussionsupporting

confidence: 60%

Effects of a Single Mannitol Bolus on Cerebral Hemodynamics in Intracerebral Hemorrhage: A Transcranial Doppler Study

Vicenzini

Ricciardi²,

Zuco

et al. 2011

Cerebrovasc Dis

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“…The patient's structurally evident cerebellar infarction was masked by subacute hyperperfusion phenomenon. This 99m Tc-HMPAO SPECT finding has been seen in up to 83% of tested patients 3 weeks after an ischemic stroke (Bowler et al, 1998;Lin et al, 1996;Moretti et al, 1990;Ogasawara et al, 2000;Sperling and Lassen, 1993).…”

Section: Figure Legendsmentioning

confidence: 89%

Akinetic Mutism Without a Structural Prefrontal Lesion

Demirtaş-Tatlıdede

Bahar

Gürvıt

2013

Cognitive and Behavioral Neurology

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Akinetic mutism is characterized by profound apathy and a lack of verbal and motor output for action, despite preserved alertness. The condition usually follows bilateral damage to the medial frontal subcortical circuits. We report a 59-year-old right-handed woman who was admitted to the neurology ward with sudden-onset akinetic mutism. Her medical history included an ischemic stroke 3 years earlier, with residual anomia and mild agraphia but no motor dysfunction. On this admission, a cranial computed tomography scan disclosed an acute left superior cerebellar infarction embracing the vermis, and a prior left inferior parietal infarct. Electroencephalogram showed bilateral frontal delta-wave activity. Four weeks later, we performed a technetium-99m hexamethylpropyleneamine oxime single-photon emission computed tomography (Tc-HMPAO SPECT) scan to study the patient's frontal lobe function. The SPECT scan revealed the causative bifrontal hypoperfusion, more prominent on the right, while the structurally evident cerebellar infarction was predictably masked by subacute hyperperfusion phenomenon. Contralateral frontal diaschisis is an established sequela of cerebellar infarction. Because this patient also had lesions in the left parietal region, her left prefrontal area was critically deprived of its major reciprocally connected cortical counterparts (right prefrontal and left parietal), and also became dysfunctional. Her resulting bilateral frontal dysfunction is a common cause of akinetic mutism.

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“…the differences in total count were expressed as a percentage of the values from the contralat eral hemisphere with a normal cerebral blood Dow. Interhemispherie difference of at least 10% was considered significant [12,13]. Crossed cerebellar diaschisis was defined by hypoperfusion in the contralateral cerebellar hemisphere to the hemispheric hypoperfu sion.…”

Section: Methodsmentioning

confidence: 99%

Clinical Usefulness of Technetium-99m HMPAO SPECT Imaging to Map the Ischemic Lesion in Acute Stroke: A Reevaluation

Laloux¹,

Doat²,

Brichant³

et al. 1994

Cerebrovasc Dis

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To address the issue of whether single-photon emission computed tomography (SPECT) may add useful topographic information to neurologic examination in clinical practice, we compared technetium-99m hexamethyl propyleneamine oxime (HMPAO) SPECT and brain CT in 100 consecutive stroke patients involving the following clinical vascular territories: cortical middle cerebral artery (CMCA), 52; deep, 39; anterior cerebral artery (ACA), 3; posterior cerebral artery (PCA), 7. SPECT and CT sensitivity were calculated as the percentage of patients with respectively focal hypoperfusion or hypodensity related to the index event. The overall sensitivity of SPECT was not significantly different from CT (69 vs. 73%). The sensitivity of SPECT was not significantly dependent on the time of investigation (72% within 24 h, 50% on day 2, and 71 % after day 3). Compared with CT, the sensitivity of SPECT was statistically significantly higher in CMCA infarcts (89 vs. 71%; p = 0.027) and lower in deep infarcts (40 vs. 69%; p = 0.024). The degree of hypoperfusion was significantly higher in cortical lesions than in deep lesions (27 vs. 9%; p < 0.001). Crossed cerebellar diaschisis seemed less frequent in patients with clinical lesion in the ACA and PCA territory (respectively 30 and 40%) and was not significantly different when the ischemic lesion involved the CMCA (56%) or deep territories (50%). No significant difference was found when SPECT took place within or after 48 h. Thus, the selective SPECT sensitivity according to the site of lesion and the degree of hypoperfusion may help to determine stroke subtypes in the acute phase. In contrast, in the subacute phase, SPECT is as sensitive as CT in mapping the ischemic lesion and should not be recommended for this purpose.

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“Luxury perfusion” with99mTc-HMPAO and123I-IMP SPECT imaging during the subacute phase of stroke

Cited by 61 publications

References 20 publications

Effects of a Single Mannitol Bolus on Cerebral Hemodynamics in Intracerebral Hemorrhage: A Transcranial Doppler Study

Effects of a Single Mannitol Bolus on Cerebral Hemodynamics in Intracerebral Hemorrhage: A Transcranial Doppler Study

Akinetic Mutism Without a Structural Prefrontal Lesion

Clinical Usefulness of Technetium-99m HMPAO SPECT Imaging to Map the Ischemic Lesion in Acute Stroke: A Reevaluation

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