Psychiatric Illness or Immune Dysfunction—Brain Perfusion Imaging Providing the Answer in a Case of Anti-NMDAR Encephalitis

Abstract

Background: We investigated the potential use of SPECT quantification in addition to qualitative brain perfusion analysis for the detection of anti-NMDAR encephalitis. The question is how to normalize brain activity to be able to quantitatively detect perfusion patterns. Usually, brain activity is normalized to a structure considered unaffected by the disease. Methods: Brain [99mTc]-HMPAO SPECT was performed as a method to detect brain perfusion patterns. The patterns of abnormal brain perfusion cannot always be reliably and qualitatively assessed when dealing with rare diseases. Recent advances in SPECT quantification using commercial software have enabled more objective and detailed analysis of brain perfusion. The cerebellum and whole brain were used as the normalization structures and were compared with visual analysis. Results: The quantification analysis performed with whole brain normalization confirmed right parietal lobe hypoperfusion while also detecting statistically significant left-to-right perfusion differences between the temporal lobe and thalamus. Whole brain normalization further described bilateral frontal lobe hyperperfusion, predominantly of the left lobe, and was in accordance with visual analysis. Conclusion: SPECT quantitative brain perfusion analysis, using the whole brain as the normalization structure rather than the cerebellum, in this case, improved confidence in the visual detection of anti-NMDAR encephalitis and provided unexpected solutions to atypical psychiatric dilemmas.

Avaliação da associação de canabidiol e nitroprussiato de sódio no prejuízo sensório-motor induzido pelo tratamento agudo com MK-801

“…O mecanismo pelo qual o NPS pode reduzir os sintomas psicóticos ainda não está totalmente elucidado. O NPS é um agente vasodilatador de ação rápida e curta e parece estimular a perfusão cerebral e, consequentemente, pode aliviar a hipoperfusão cerebral (LEE et al, 2022b;OLESEN;FISCHER;SECHER, 2018), uma característica comum dos pacientes com esquizofrenia (CASAS et al, 2018;ŠIŠKO MARKOŠ et al, 2022;WAKE et al, 2016). Além disso, o NPS parece exercer um efeito tônico na via NMDA-nNOS-cGMP, cuja funcionalidade é comprometida nesse transtorno (HALLAK et al, 2013).…”