123I-IMP SPECT Research Articles

Dropped Head Syndrome Preceding the Onset of Dementia with Lewy Bodies

A 67-year-old woman developed dropped head. Her neck was severely flexed, with prominent cervical paraspinal muscles, although no parkinsonism was observed. Brain MRI showed no significant findings. We considered dystonia as the cause of the dropped head and administered trihexyphenidyl, an anticholinergic. After 10 years of follow-up, remarkable psychotic symptoms, including hallucinations regarding insects, appeared. Following the discontinuation of trihexyphenidyl, the psychotic symptoms decreased but still remained. (123)I-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography ((123)I-IMP SPECT) revealed hypoperfusion in the bilateral occipital lobes. We diagnosed the patient with dementia with Lewy bodies (DLB). This case suggests that dropped head syndrome may precede the onset of DLB.

Diagnosis of dementia with Lewy bodies: diagnostic performance of combined 123I-IMP brain perfusion SPECT and 123I-MIBG myocardial scintigraphy

Objective We assessed the value of combining 123I-IMP brain perfusion SPECT and 123I-MIBG myocardial scintigraphy for the discrimination of dementia with Lewy bodies (DLB) from other types of dementia. MethodsWe subjected 252 consecutive patients with clinically suspected DLB to both 123I-IMP brain perfusion SPECT and 123I-MIBG myocardial scintigraphy. Patients with Parkinson’s disease were included. The 252 patients were randomly assigned to an estimation (n = 152) or a validation group (n = 100). Using univariate analysis, we first analyzed the relationship between various variables and the presence or absence of DLB in estimation group and then proceeded to multivariate analysis to obtain a combined index that predicted the likelihood of DLB. The diagnostic value of the index was assessed by calculating the area under the receiver operating characteristic (ROC) curve (AUC) with the cutoff value selected from the ROC curve. We then tested the predictive accuracy of the index in validation group. ResultsThe combined index was an arithmetic expression that combined the age, early 123I-MIBG heart-to-mediastinum uptake (E-H/M) ratio, and the parietal lobe hypoperfusion score. Values for the AUC of the combined index, the E-H/M ratio, the parietal lobe hypoperfusion score, and the patient age in validation group were 0.95, 0.90, 0.72, and 0.73, respectively. There was a significant difference in the AUC of the combined index among other indices (p < 0.05). The sensitivity, specificity, and accuracy of the combined index for a diagnosis of probable DLB in validation group were 88, 87, and 87 %, respectively.ConclusionsThe combinational diagnosis based on 123I-IMP brain perfusion SPECT, 123I-MIBG myocardial scintigraphy, and the patient age is a simple and reliable means for predicting probable DLB.

Combined Measurement of Cerebral and Cerebellar Blood Flow on Preoperative Brain Perfusion SPECT Imaging Predicts Development of New Cerebral Ischemic Events After Endarterectomy for Symptomatic Unilateral Cervical Carotid Stenosis

The aim of this study was to determine whether the ratio of blood flow contralateral-to-affected asymmetry in the cerebellar hemisphere to blood flow affected-to-contralateral asymmetry in the middle cerebral artery (MCA) territory (AR(cbl)/AR(MCA)) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after carotid endarterectomy (CEA) for symptomatic unilateral cervical carotid stenosis. For the purposes of this study, new cerebral ischemic events included neurological deficits and cerebral ischemic lesions on diffusion-weighted MRI. Brain blood flow was assessed using 123I-IMP SPECT in 101 patients. A region of interest was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a 3-dimensional stereotaxic region-of-interest template, and the AR(cbl)/AR(MCA) was calculated. Diffusion-weighted MRI was performed within 3 days before and 24 hours after surgery. Patients were neurologically tested before induction of general anesthesia and after recovery from general anesthesia. New cerebral ischemic events after CEA were observed in 12 patients (12%). Multivariate analysis revealed that only high AR(cbl)/AR(MCA) was significantly associated with the development of new postoperative cerebral ischemic events (95% confidence interval, 1.945-8.452; P = 0.0070). The AR(cbl)/AR(MCA) provided 75% sensitivity, 84% specificity, and 39% positive and 96% negative predictive values in predicting development of new postoperative cerebral ischemic events. The AR(cbl)/AR(MCA) on preoperative brain perfusion SPECT could identify patients at risk for new cerebral ischemic events after CEA for unilateral cervical carotid stenosis.

Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery

Introduction —It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods. Hypothesis —Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery. Methods —This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery Results —Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2. Conclusion —This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

Cerebral hemodynamic benefits after contralateral carotid artery stenting in patients with internal carotid artery occlusion.

CEA contralateral to an ICA occlusion is considered a surgical risk, and CAS may be an alternative for these patients. Our goal was to examine whether CAS improves cerebral hemodynamics on the treated side and on the side of the ICA occlusion, on the basis of measurement of CBF and CVR by using SPECT. The subjects were 8 patients who underwent contralateral CAS. Resting CBF and CVR to acetazolamide were measured by using (123)I-IMP SPECT before and chronically (3-6 months) after CAS. Resting CBF was also measured immediately (<2 hours) after CAS by using (123)I-IMP SPECT. There were no significant differences in resting CBF in both hemispheres immediately after CAS. However, resting CBF and CVR both significantly increased in the chronic period in both hemispheres. Contralateral CAS in patients with ICA occlusion resulted in cerebral hemodynamic improvement on the treated side and on the side of ICA occlusion.

副腎皮質ステロイドおよび化学療法にて寛解をえたlymphomatosis cerebriの1例

Lymphomatosis cerebri (LC) is a rare form of primary central nervous system lymphoma characterized by subacute progressive dementia and unsteady gait. MRI study of LC typically reveals diffuse leukoencephalopathy without contrast enhancement. The clinical presentation and MRI features of LC can resemble infectious, inflammatory, toxic or vascular leukoencephalopathy. Hence diagnosis of LC is easily mistaken for other, more common diseases. In this report, we present a case of a 55-year-old man presenting with subacute progressive dementia and ataxic gait. Brain MRI showed diffuse hyperintense lesions in the cerebral white matter of both hemispheres, left amygdala, brainstem and cerebellar peduncles on FLAIR image. No contrast-enhanced lesion was observed. Cerebrospinal fluid analysis showed elevated levels of soluble interleukin-2 receptor and β2-microglobulin. Based on MRI findings and 123I-IMP SPECT, stereotactic biopsy targeting white matter of the left medial temporal lobe was performed (day 0). On the day after the brain biopsy, corticosteroid therapy was initiated and improved the patient's cognitive function and gait disturbance. Pathological diagnosis of large B-cell lymphoma was obtained on day 9. High-dose intravenous methotrexate chemotherapy was started on day 14 and led to complete remission by day 52. This case highlighted the importance of brain biopsy for diagnosis of LC. This report raises a possibility that timely and proper treatment leads to a favorable outcome of LC that has been regarded as an intractable disease with poor prognosis.

FTDP-17 presenting amnestic MCI as an initial symptom: case report

A 46-year-old woman was admitted to our hospital for examination of her amnesia. Psychiatric examinations revealed that her recent memory was moderately disturbed despite well-preserved general cognitive function. Brain MRI and I-IMP SPECT (eZIS) revealed mild brain atrophy and hypoperfusion localized to the hippocampus, superior parietal lobule, and posterior cingulate gyrus. She was diagnosed with amnestic MCI at that time. However, five years later, she developed personality changes, parkinsonism and dementia. Investigation of her family medical history revealed that the patient's two sisters are demented and under the medical care. DNA analysis revealed an intronic mutation IVS10 C>T in the MAPT gene. Although her two sisters also have the same mutation, her elder sister has typical FTD without parkinsonism. Approximately 10% of patients with amnestic MCI develop Alzheimer's disease each year. Thus, amnestic MCI has been usually considered to be an early stage of Alzheimer's disease. Interestingly our patient having a MAPT gene mutation started to develop amnestic MCI as an initial symptom. Therefore because of the diversity in early clinical features of FTDP-17, aggressive DNA analysis is necessary for accurate diagnosis.

Perfusion 123IMP‐SPECT shows reversible abnormalities in GABAB receptor antibody associated encephalitis with normal MRI

A new subtype of autoimmune encephalitis associated with antibodies against GABAB receptor was recently identified. Although immune-mediated functional abnormalities are suggested for the pathogenesis, functional brain imaging such as perfusion SPECT has not been documented. A 62-year-old woman with anti-GABAB receptor associated encephalitis underwent 123I-IMP SPECT in the beginning and after methylprednisolone pulse therapy. Three-dimensional stereotactic surface projection analysis was used to evaluate the cortical distribution of perfusion abnormality. The patient presented with clinical features of subacute limbic encephalitis. Antibodies to GABAB receptor were identified in her serum and cerebrospinal fluid (CSF), but no tumor was detected. Despite normal magnetic resonance imaging (MRI) findings, the first SPECT revealed hypoperfusion of the frontal, parietal and medial temporal lobes, as well as thalamus, and cerebellum. These areas are known to contain high levels of GABAB receptors. In contrast, the SPECT revealed hyperperfusion in the motor strip and left temporal lobe, which are areas related to some of the patient's symptoms, including seizures, orolingual dyskinesia, and Wernicke aphasia. After treatment with pulses of methylprednisolone, the neuropsychiatric symptoms resolved and the SPECT findings showed substantial improvement in most of these regions. In conclusion, the findings suggest that immunotherapy improved the cortical dysfunction mediated by GABAB receptor antibodies.

Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

Risk factors for cerebrovascular complications developing during or after carotid endarterectomy (CEA) include preoperative impairments in cerebral hemodynamics, as detected by the demonstration of decreased cerebrovascular reactivity (CVR) to acetazolamide on brain perfusion SPECT. Central benzodiazepine receptor binding potential (CBRBP) and cerebral blood flow (CBF) images on SPECT provide high sensitivity and high specificity for detecting misery perfusion in patients with chronic unilateral major cerebral artery occlusive disease. The aim of the present study was to determine whether preoperative CBRBP/CBF images on SPECT could identify patients at risk for new cerebral ischemic events, including neurologic deficits and cerebral ischemic lesions on diffusion-weighted MRI, or cerebral hyperperfusion after CEA and to compare the predictive accuracy of CBRBP/CBF with that of CVR to acetazolamide on SPECT. CBF, CVR, and CBRBP were assessed using N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) and (123)I-iomazenil SPECT before CEA in 112 patients with unilateral internal carotid artery stenosis (≥ 70%). CBF measurement using (123)I-IMP SPECT was also performed immediately and 3 d after CEA. A region of interest was automatically placed in the middle cerebral artery territory in both cerebral hemispheres using a 3-dimensional stereotactic region-of-interest template. Diffusion-weighted MRI was performed within 3 d before and 24 h after surgery. A preoperative increase in the affected side-to-contralateral side asymmetry on CBRBP/CBF value was the only significant independent predictor of postoperative new cerebral ischemic events (95% confidence intervals [CI], 1.145-1.608; P = 0.0004) or post-CEA hyperperfusion (95% CI, 1.244-2.252; P = 0.0007). There was no difference in the ability to predict post-CEA hyperperfusion when comparing the area under the receiver-operating-characteristic curve of the affected side-to-contralateral side asymmetry on CBRBP/CBF and that of the CVR in the affected hemisphere. However, the former value (0.924; 95% CI, 0.854-0.972) was significantly greater than the latter value (0.782; 95% CI, 0.697-0.852) for the prediction of new postoperative cerebral ischemic events (P < 0.05). Preoperative CBRBP/CBF images on SPECT can more accurately identify patients at risk for cerebrovascular complications occurring during or after CEA when compared with preoperative CVR to acetazolamide.

脳血管攣縮 くも膜下出血後脳血管攣縮期の脳血流評価におけるｖａｓｏｐａｒａｌｙｓｉｓの頻度と病態に関しての検討

We employ the 123I-IMP SPECT dual table ARG method and stereotactic extraction estimation (SEE) analysis 7 or 8 days after subarachnoid hemorrhage (SAH) onset to predict cerebral vasospasm. We report new findings of cerebral vasoparalysis during a period of cerebral vasospasm after SAH. From January 1, 2005 to April 30, 2008, we encountered 330 cases of aneurysmal SAH, and treated 285 cases. Of these, 65 were excluded as unsuitable for this study, for reasons such as lack of SPECT data, external decompression, admission over 7 days from SAH onset. We studied 220 cases treated by microsurgical clipping (n＝178) or endovascular coil embolization (n＝42). Vasoparalysis was defined as a rise in resting CBF and a loss of vascular reserve on SEE analysis of CBF-SPECT. Vasoparalysis occurred in 15 cases (6.8%). Of these, 9 cases (60.0%) had cerebral hematoma, temporary clips had been used in the operation for 8 cases (53.3%), 9 cases (60.0%) experienced postoperative cerebral infarction, and 3 cases (20.0%) had postoperative convulsions. Vasoparalysis occurs in relation to perioperative cerebral damage. In terms of the loss of vascular reserve following SAH, vasoparalysis resembles hemodynamic cerebral ischemia, although the conditions are quite different. Differentiating between these 2 conditions is important, as different forms of management are required. Dual table ARG and SEE analysis are very useful for the evaluating these 2 conditions.

A Pilot Study for the Effects of Donepezil Therapy on Cerebral and Optic Nerve Head Blood Flow, Visual Field Defect in Normal-Tension Glaucoma

To evaluate the effect of donepezil hydrochloride, an agent for the treatment of Alzheimer's disease (AD), on the cerebral and optic nerve head (ONH) blood flow, visual field defect in normal-tension glaucoma (NTG) patients with decreased cerebral blood flow (CBF) that demonstrates an AD-like perfusion pattern. The subjects were 5 NTG patients who exhibited AD-like decreased CBF upon (123)I-iodoamphetamine single photon emission computed tomography ((123)I-IMP SPECT). Donepezil hydrochloride (5 mg/day) was prescribed for each patient during a period of 12 months. Intraocular pressure (IOP), mean deviation (MD) of the Humphrey visual field, ONH blood flow determined by a laser speckle flowgraphy, and regional CBF (rCBF) determined by (123)I-IMP SPECT were measured before and every 6 months during the treatment. MD, ONH blood flow, and rCBF were improved significantly after 6 months of the treatment, although IOP did not change significantly. No deterioration of NTG morbidity was found in any of the measured parameters after 12 months of the treatment. Oral administration of donepezil hydrochloride in NTG patients might prevent deterioration of visual field defect, ONH blood flow, and rCBF in the temporal, parietal, and posterior lobes. This pilot study suggested the possibility that donepezil hydrochloride might ameliorate glaucomatous optic neuropathy in NTG.

A Case of Malignant Lymphoma That Presented with Characteristic Brain Imaging: Usefulness of FDG-PET and &lt;sup&gt;123&lt;/sup&gt;I-IMP SPECT to Detect the CNS Spread of the Disease.

A Case of Malignant Lymphoma That Presented with Characteristic Brain Imaging: Usefulness of FDG-PET and &lt;sup&gt;123&lt;/sup&gt;I-IMP SPECT to Detect the CNS Spread of the Disease.

左中前頭回後部限局性梗塞により不全型Ｇｅｒｓｔｍａｎｎ症候群・超皮質性感覚失語を呈した６５歳男性例

A 65-year-old right-handed man noted a sudden onset of numbness and weakness of the right hand. On the initial visit to our hospital, he showed severe acalculia, and transient agraphia (so called incomplete Gerstmann syndrome) and transcortical sensory aphasia. Brain MRI revealed a fresh infarct in the left middle frontal gyrus. The paragraphia and aphasia improved within 14 days after onset, but the acalculia persisted even at seven months after onset In an 123I-IMP SPECT study, the cerebral blood flow (CBF) was found to be decreased in the infarction lesion and its adjacent wide area, the ipsilateral angular and supramarginal gyri, and contralateral cerebellar hemisphere. We speculate that inactivation in the infarction lesion caused the CBF decrease in the non-infarcted areas due to diaschisis. This case indicates that Gerstmann syndrome can be caused by not only dysfunction of the angular gyrus but also of the left middle frontal gyrus in the dominant hemisphere.

Transient subacute cerebellar ataxia in a patient with Lambert-Eaton myasthenic syndrome after intracranial aneurysm surgery

Several reports have presented patients with subacute cerebellar ataxia (CA) and Lambert-Eaton myasthenic syndrome (LEMS). Some clinical features of those patients have been described in the previous reports, manifestation of subacute CA prior to LEMS or a co-existence of both diseases, a high incidence of malignancy, and less efficacy of the treatment for subacute CA compared with that for LEMS. Cerebellar ataxia in some patients with LEMS has been suggested to be caused by antibodies to P/Q-type voltage-gated calcium channels (VGCCs). We report herein a patient with subacute CA and LEMS. Cerebellar ataxia appeared 15 months after the occurrence of LEMS, and the onset of CA was thought to be due to serum anti-P/Q-type VGCC antibodies. The clinical course of this patient was atypical, as follows: (1) LEMS preceded subacute CA, which developed after intracranial aneurysm surgery, (2) no malignancy was detected when both diseases co-existed, (3) symptoms of LEMS did not progress with the onset of CA, and (4) there was a definite improvement in symptoms of CA and 123I-IMP SPECT imaging findings after steroid administration. In addition, it is remarkable that LEMS became aggravated in electrophysiologic examinations, in contrast to subacute CA. We suggest that these atypical features of subacute CA and the changes in LEMS may be associated with a balance between the amount of serum anti-P/Q-type VGCC antibodies and the susceptibility of the cerebellum and presynaptic nerve terminals to the antibodies. More cases are needed to investigate the mechanisms involved. The subacute CA and LEMS in this patient have remained comparatively silent after the withdrawal of steroids, and we are continuing to observe her condition.

左内側後頭頭頂葉病変で発症したｐｏｓｔｓｔｒｏｋｅ ｄｅｍｅｎｔｉａの１例

We report herein a patient of poststroke dementia (PSD) following left medial occipitoparietal hemorrhage triggered by drainage of an acute traumatic subdural hematoma. The patient, an independent 73-year-old man, became dependent due to dementia. Cognitive dysfunction was characterized by moderately decreased IQ, severe memory disturbances, topographical disorientation, executive dysfunction and loss of self-awareness. Cognitive dysfunction has not advanced for 3 years. Hypo-perfusion in the whole brain, particularly in the left temporal and parietal regions, was visible on 123I-IMP SPECT images. Magnetic resonance imaging demonstrated damage to the left posterior cingulate cortex, cingulate bundle, superior parietal lobule and subcortical region of the occipital lobe. The fornix was spared. Some subcortical small spotted lesions were detected, but periventricular lucency was not prominent. Structures known to be important in memory but spared by the lesion included the thalamus and basal forebrain. Small spotted subcortical lesions were detected in bilateral hippocampi, which are also known to be important in memory, but these were probably silent lesions. This case suggested that dementia is brought on by the lesion of the left posterior cingulate bundle and retrosplenial cortex causing amnesia by disrupting the cingulate-hippocampal connection or the retrosplenial cortex itself, with the lesion of the left occipitoparietal subcortex causing frontal dysfunction by disrupting the dorsal limbic pathway and occipitofrontal fasciculus of the prefrontal circuits.

Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by (123)I-metaiodobenzylguanidine ((123)I-MIBG), and myocardial function by electrocardiographically gated (99m)Tc-sestamibi ((99m)Tc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Twelve patients with probable DLB (7 male, 5 female; mean age +/- SD, 72.3 +/- 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age +/- SD, 73.1 +/- 9.23 y; range, 59-88 y) were enrolled in this study. (123)I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated (123)I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed (99m)Tc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low (123)I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal (123)I-MIBG uptake. (99m)Tc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with (123)I-MIBG, would be a useful supporting diagnostic method in patients with DLB-particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

Thalamic Hyperperfusion in Verbal Hallucination of Parkinsonian Patients

We compared brain perfusion image using 3D-SSP analysis of (123)I-IMP SPECT between Parkinson's disease patients with auditory verbal hallucination and those without auditory hallucination. Eighty-three cases with Parkinson's disease were studied. In 6 of these patients, auditory hallucination was noted. Among them, four cases had verbal hallucination and two other cases had elementary hallucination. Auditory hallucination was not found in the other 77 cases. Right thalamic perfusion was significantly increased in the verbal hallucination group compared to the group that lacked auditory hallucination. In Parkinson's disease, the right thalamic hyperactive state may be related to verbal hallucination.

Quantification of the regional cerebral blood flow and vascular reserve in moyamoya disease using split-dose iodoamphetamine I 123 single-photon emission computed tomography

Objectives We quantified the rCBF and regional vascular reserve (CVR) in adult patients with moyamoya disease before and after surgery using IMP I 123 SPECT. Methods The patient population included 5 adult patients with ages at presentation ranging between 23 and 42 years. One patient had stroke, whereas 4 patients had transient ischemic attacks. Results Before surgery, the mean resting rCBF and mean CVR in the frontal, parietal, and temporal lobes of the surgically treated hemisphere were 40.09, 39.50, and 36.9 mL/100 g per minute and 15.39%, 27.09%, and 28.92%, respectively. After surgery, the rCBF increased significantly ( P = .0002, .0005, and .0062), but in a CVR evaluation, only the frontal lobe increased significantly ( P = .0055). In the unaffected hemispheres, the mean resting rCBF significantly increased only in the frontal lobe ( P = 038) and no significant increase in the CVR was observed after surgery. In 2 patients who showed steal phenomenon induced by acetazolamide administration, CVR significantly increased not only in the frontal lobe but also in the parietal and temporal lobe after surgery, although the CVR in these areas significantly decreased both before and after surgery in comparison to the mean CVR in all patients. Conclusions The frontal lobe showed severe hemodynamic ischemia. The cerebral hemodynamics in patients with moyamoya disease improved after surgical intervention, especially in severely damaged patients. Split-dose 123I-IMP SPECT was therefore found to be a useful diagnostic modality for quantifying the hemodynamics of moyamoya disease.

P2-379: Memory function tests correlate differently to regional cerebral blood flow in mild cognitive impairment and Alzheimer’s disease. A 123I-IMP SPECT study with statistical parametric mapping

P2-379: Memory function tests correlate differently to regional cerebral blood flow in mild cognitive impairment and Alzheimer’s disease. A 123I-IMP SPECT study with statistical parametric mapping

I.P8 Incessant drawing in a patient with advanced stage Parkinson Disease

Introduction: Patients with advanced stage Parkinson disease (PD) are often characterized by cognitive decline and behavioral abnormalities associated with loss of motor function. Objective: To report on a patient who exhibited incessant drawing in advanced stage of PD supposed to be due to disease process or treatment related. Patient description: At Hoehn and Yahr stage III, a 70-year old excarpenter treated as PD for more than 15 years developed drawing habit abruptly in summer of 2003 for the first time of his life. His PD began with lt hand tremor and clinical picture at the appearance of PD was characterized by camptocormia, constant orolingual dyskinesia, mild visual hallucination, and mild cognitive impairment. His drawing has been done only from inner memory with happy feeling and continues throughout daytime if not interrupted by family until present. No obsessive compulsive thought was recognized. Antiparkinsonian medication comprised L-dopa/ carbidopa 450/45mg/day, trihexyphenidil 12mg/day, pergolide 1.5mg/day, selegiline 5mg/day, and amantadine 100mg/day. Neither brain MRI in Januari 2006 nor 123I-IMP SPECT in March 2006 disclosed significant abnormalities. Neuropsychological Investigation: Neuropsychological examination in Mar 2006 showed MMSE 27/30, Frontal Assessment Battery 8/18, and Raven’s Colored Progressive Matrices 21/36. Scarce reports have been written about increased drawing activity in patients with PD. Conclusion: Present case illustrates that enhanced visuospacial productivity can occur during the course and treatment of PD and it can be utilized for improvement of wellness of some patients with this debilitating disease.