Hypoperfusion following encephalitis: SPECT with acetazolamide

Abstract

At 4 weeks and 8 months following initial symptoms, we performed single-photon emission computed tomography (SPECT) with acetazolamide (ACZ) testing in a patient recovering from acute encephalitis, possibly acute disseminated encephalomyelitis (ADEM). Both regional hypoperfusion at baseline and diminished cerebrovascular reserve were seen after focal hyperintensities had disappeared in magnetic resonance imaging (MRI). The time course of SPECT abnormalities reflected the clinical course more closely than the time course of MRI abnormalities. Thus, persistent cerebral circulatory impairment probably contributed to cognitive and language deficits observed at the subacute stage.

A rare case of cerebral vasculitis in Henoch‐Schönlein purpura with emphasis on the diagnostic value of magnetic resonance angiography (MRA) and single‐photon emission computed tomography (SPECT) given normal magnetic resonance imaging (MRI)

“…It has not been adequately evaluated for cerebral vasculitidies in childhood, however, and there are no case reports using it for diagnosis of cerebral vasculitis in childhood HSP. In vasculitidies of other origins such as acute disseminated encephalomyelitis, systemic lupus erythematosus and viral infections, there are several case reports that support the usefulness of SPECT in the evaluation of CNS lesions 11–13 . In particular, Okamoto et al.…”

“…In particular, Okamoto et al. 11 suggested that the time course of SPECT abnormalities reflects the clinical course more closely than does the time course of MRI abnormalities. In our case, the results both between brain SPECT and MRA as well as between the clinical course and SPECT were well correlated.…”

Serial Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Study of Acute Disseminated Encephalomyelitis Patient after Japanese Encephalitis Vaccination

“…Because of the delay between the onset of symptoms and the appearance of ADEM-associated MR imaging, SPECT has contributed to identification of regions with functional deficits at different stages of the disease [11][12][13]. Okamoto et al [12] reported that persistent hypoperfusion both at rest and in response to acetazolamide administration remained even after disappearance of hyperintensive lesions from MRI, suggesting persistent impairment of cerebral circulation affecting cognitive abilities.…”

“…Okamoto et al [12] reported that persistent hypoperfusion both at rest and in response to acetazolamide administration remained even after disappearance of hyperintensive lesions from MRI, suggesting persistent impairment of cerebral circulation affecting cognitive abilities. A previous HMPAO-SPECT study of a patient with ADEM revealed a combined pattern of hyper and hypoperfusion regions and the presence of inflammatory cells and cortical deactivation secondary to disconnection from the subcortical structures, respectively [13].…”

Pediatric Inflammatory Diseases

“…SPECT with acetazolamide showed persistent hypoperfusion after resolution of MRI abnormalities. This aspect could have important prognostic implications in patients with persistent cognitive deficits after ADEM 30 .…”