Cerebral blood flow changes in general paresis following penicillin treatment: A longitudinal single photon emission computed tomography study

Abstract

Three cases of general paresis were successfully treated with high-dose penicillin. In all cases, cerebrospinal fluid cell counts decreased to normal and mental status improved rapidly. Cerebrospinal fluid protein concentrations decreased and IQ scores and overall levels of functioning improved gradually over 1 year. Regional cerebral blood flow (CBF) changes were analyzed longitudinally for 1 year using single photon emission computed tomography (SPECT). Autoradiography method and region of interest (ROI) analyses were used for quantitative CBF assessment and 3D stereotactic surface projections (3D-SSP) analyses were used for qualitative CBF pattern assessment. 3D-SSP could not reveal remarkable CBF pattern changes through the courses. The ROI analyses showed remarkable CBF decreases in all brain regions 1 month after the treatment, which recovered to normal levels 1 year after the treatment. These results suggest that remarkable decreases of quantitative CBF counts reflect the disappearance of encephalitis, while their gradual recovery reflects the gradual improvement of cerebral functional activity. As Treponema pallidum infection affects whole brain and CBF changes globally, quantitative CBF assessment may be more efficient than qualitative CBF pattern analyses for the purpose of understanding the pathophysiology of general paresis.

Neuropsychological Features in Patients with General Paresis of the Insane at an Early Stage

“…The perfusion of the regions of interest and glucose metabolism were found to be increased. After penicillin G (24 million units/day for 21 days) treatment, the perfusion and glucose metabolism were decreased [ 43 ]. This was the same as other changes in acute encephalitis, that focal unilateral hyper-perfusion was an indicator of severe inflammation of the brain tissue [ 44 ].…”

Cerebaral Hyperperfusion in General Paralysis Patients

“…Some studies have found that there was local hoperperfusion in AD patients [17], but whether there is CBF change in GP has not been reported. To the best of our knowledge, the research on CBF in GP is limited to the change of CBF before and after penicillin treatment [18]. Kitabayashi had reported that quantitative CBF remarkably decreased in GP patients following penicillin treatment, meanwhile, the CSF cell count decreased and the mental status the decrease of CBF indicates the disappearance of encephalitis.…”

Medial temporal lobe atrophy as a predictor of poor cognitive outcomes in general paresis

“…Notably, we found that WMH of GP patients was mainly focused in the frontal cortex, bilateral temporal and periventricular areas; therefore, their attention networks may have been greatly influenced. After penicillin therapy, the slow recovery of cerebral blood flow (YurinosukeKitabayashi et al, 2002) may result in the a reduction of WMH area and contribute to the resumption of attention network of GP patient. However, the Fazekas scale scores were not an effective predictor of clinical outcomes in our study.…”