Left Parieto-occipital Region Research Articles

Frequency-dependent changes in sensorimotor and pain affective systems induced by empathy for pain.

BackgroundEmpathy for pain helps us to understand the pain of others indirectly. To better comprehend the processing of empathic pain, we report the frequency-dependent modulation of cortical oscillations induced by watching movies depicting pain using high-density electroencephalography (EEG), magnetoencephalography (MEG), and motor evoked potentials (MEP).MethodsEvent-related desynchronization of EEG and MEG was assessed while participants viewed videos of painful (needle) or neutral (cotton swab) situations. The amplitudes of MEPs were also compared between the needle and cotton swab conditions.ResultsThe degree of suppression in α/β band power was significantly increased, whereas that of γ band power was significantly decreased, in the needle condition compared with the cotton swab condition. EEG revealed that significant differences in α/β band were distributed in the right frontocentral and left parietooccipital regions, whereas significant γ band differences were distributed predominantly over the right hemisphere, which were confirmed by source estimation using MEG. There was a significant positive correlation between the difference in γ power of the two conditions and the visual analog scale subjective rating of aversion, but not in the α/β band. The amplitude of MEPs decreased in the needle condition, which confirmed the inhibition of the primary motor cortex.ConclusionMEP suppression supports that modulation of cortical oscillations by viewing movies depicting pain involves sensorimotor processing. Our results suggest that α/β oscillations underlie the sensory qualities of others’ pain, whereas the γ band reflects the cognitive aspect. Therefore, α/β and γ band oscillations are differentially involved in empathic pain processing under the condition of motor cortical suppression.

Cortical Epandimoma with Extention to Thalamus

Ependymomas are glial tumors originate from ependymal cells lining the ventricles and the central canal of the spinal cord. Two thirds of ependymomas arise in the infratentorial or intraventriclesandone-third aredetected in supratentorial area. However supratentorial “cortical” ependymomas are veryuncommon. Ependymomas are usually infratentorial, intraventricular tumor, including 2–9% of all central nervous system tumors. We present a unique case of an anaplastic cortical ependymomain a 48-year-old man. The patient presented with transient amnesia and right weakness and seizure. This tumor was located in the left parieto-occipital region with extension to corpus callosum and thalamus. Microscopy and immunohistochemistry showed grade III differentiation ependymoma.

Combined Microneurosurgical and Endovascular Management of Grade V Occipital Arteriovenous Malformation: Sequential Delayed Embolization Holds the Key!

A 26-year-old previously healthy woman presented with complaints of sudden-onset headache, decreased level of consciousness, right hemiparesis, and hemianopia. Computed tomography (CT) of the head showed a leftsided parietal hematoma (►Fig. 1). CT angiography showed a complex arteriovenous malformation (AVM) with a venous varix in the center of the hematoma. Cerebral angiogram revealed a grade V AVM in the left parieto-occipital region measuring 6 4 cm and supplied by left posterior cerebral artery (PCA) and middle cerebral artery (MCA) and draining into superior sagittal sinus (SSS) and straight sinus via internal occipital vein/vein of Galen (►Fig. 2). Elective sequential endovascular embolization of the nidus was planned over 3 months in four settings. The aim of partial embolization over weeks was to occlude deep feeders and reduce the nidus to allow definitive treatment, either surgical resection or radiosurgery. Gradual flow reduction should also help prevent normal perfusion pressure breakthrough (NPPB) that might happen due to sudden hemodynamic changes during rapid occlusion of large, highflow AVMs. The treatment plan was developed in a way that each embolization would occlude less than 40% of the arterial feeders and nidus penetration would be limited. MCA feeders were embolized first, followed by the PCA feeders. Onyx (Covidien; Irvine, California, United States) was used in all sessions. It is composed of EVOH (ethylene vinyl alcohol) copolymer dissolved in DMSO (dimethyl sulfoxide), and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy. Standard technique was used with Apollo catheters with Mirage guidewires (Covidien; Irvine, California, United States) and Onyx 18 and 34 was injected into the nidus. The choice between 18 and 34 was based on flow characteristics observed during the superselective angiograms. At the end of last session of embolization, only small superficial cortical MCA and PCA feeders were left patent (►Fig. 3). The little flow lead to the decision to surgically excise the nidus. The patient underwent left-sided occipital craniotomy and excision of the nidus without complications (►Fig. 4). Postoperative angiogram showed complete resection (►Fig. 5).

Microstate connectivity alterations in patients with early Alzheimer's disease.

IntroductionElectroencephalography (EEG) microstates and brain network are altered in patients with Alzheimer’s disease (AD) and discussed as potential biomarkers for AD. Microstates correspond to defined states of brain activity, and their connectivity patterns may change accordingly. Little is known about alteration of connectivity in microstates, especially in patients with amnestic mild cognitive impairment with stable or improving cognition within 30 months (aMCI).MethodsThirty-five outpatients with aMCI or mild dementia (mean age 77 ± 7 years, 47 % male, Mini Mental State Examination score ≥24) had comprehensive neuropsychological and clinical examinations. Subjects with cognitive decline over 30 months were allocated to the AD group, subjects with stable or improving cognition to the MCI-stable group. Results of neuropsychological testing at baseline were summarized in six domain scores. Resting state EEG was recorded with 256 electrodes and analyzed using TAPEEG. Five microstates were defined and individual data fitted. After phase transformation, the phase lag index (PLI) was calculated for the five microstates in every subject. Networks were reduced to 22 nodes for statistical analysis.ResultsThe domain score for verbal learning and memory and the microstate segmented PLI between the left centro-lateral and parieto-occipital regions in the theta band at baseline differentiated significantly between the groups. In the present sample, they separated in a logistic regression model with a 100 % positive predictive value, 60 % negative predictive value, 100 % specificity and 77 % sensitivity between AD and MCI-stable.ConclusionsCombining neuropsychological and quantitative EEG test results allows differentiation between subjects with aMCI remaining stable and subjects with aMCI deteriorating over 30 months.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-015-0163-9) contains supplementary material, which is available to authorized users.

Spontaneous acute epidural hematoma developed due to skull metastasis of hepatocelluar carcinoma: A case report and review of the literature.

Acute epidural hematoma (AEDH) is one of the most common pathological types of head trauma, and may develop without an accidental event, although this is uncommon. The present study reports the case of a 41-year-old male patient that developed spontaneous AEDH due to skull metastasis of hepatocellular carcinoma (HCC). The man was admitted to Chonnam National University Hwasun Hospital and Medical School due to drowsiness and right-sided hemiparesis. A computed tomography scan of the head revealed the presence of a large AEDH and a lytic bone lesion in the left posterior fossa and parieto-occipital region, which exhibited heterogeneous enhancement. The perioperative findings revealed a large amount of mixed-stage epidural hematoma and a soft hemorrhagic mass that exhibited lytic change on the occipital bone. No evidence of head trauma, such as skull fracture or scalp contusion, was detected. The pathological diagnosis was hematoma with metastatic HCC. The current study reports the rare case of a patient with a metastatic tumor located in the skull that resulted in the development of spontaneous AEDH. Once a sudden and unpredicted neurological deficit occurs in a patient with HCC that is also diagnosed with skull metastasis, the possibility of spontaneous AEDH developing from the metastasis should be considered.

Oscillatory entrainment of the motor cortical network during motor imagery is modulated by the feedback modality

Neurofeedback of self-regulated brain activity in circumscribed cortical regions is used as a novel strategy to facilitate functional restoration following stroke. Basic knowledge about its impact on motor system oscillations and functional connectivity is however scarce. Specifically, a direct comparison between different feedback modalities and their neural signatures is missing.We assessed a neurofeedback training intervention of modulating β-activity in circumscribed sensorimotor regions by kinesthetic motor imagery (MI). Right-handed healthy participants received two different feedback modalities contingent to their MI-associated brain activity in a cross-over design: (I) visual feedback with a brain–computer interface (BCI) and (II) proprioceptive feedback with a brain–robot interface (BRI) orthosis attached to the right hand. High-density electroencephalography was used to examine the reactivity of the cortical motor system during the training session of each task by studying both local oscillatory power entrainment and distributed functional connectivity.Both feedback modalities activated a distributed functional connectivity network of coherent oscillations. A significantly higher skill and lower variability of self-controlled sensorimotor β-band modulation could, however, be achieved in the BRI condition. This gain in controlling regional motor oscillations was accompanied by functional coupling of remote β-band and θ-band activity in bilateral fronto-central regions and left parieto-occipital regions, respectively. The functional coupling of coherent θ-band oscillations correlated moreover with the skill of regional β-modulation thus revealing a motor learning related network.Our findings indicate that proprioceptive feedback is more suitable than visual feedback to entrain the motor network architecture during the interplay between motor imagery and feedback processing thus resulting in better volitional control of regional brain activity.

Exploring normative working memory variance to better understand disparities in risk for drug use disorders

Deep brain stimulation (DBS) has been a major advance in the treatment of dystonias. Outcomes are, however, less predictable for secondary dystonias, predominantly due to progression of disease or specific brain lesions. There are few cases reported of globus pallidus internus (GPi)-DBS for posttraumatic dystonia. We describe the successful use of unilateral GPi-DBS in a patient with hemidystonia following penetrating head injury. To our knowledge, this is the first description of the use of DBS following penetrating head injury.We present the case of a 47-year-old man with phasic hemidystonia. At the age of 3 years he suffered a penetrating head injury from a welding needle. The patient developed dystonic and phasic right-sided movements. Preoperative Burke-Fahn-Marsden score was 26. Magnetic resonance imaging showed a linear encephalomalacic track extending from the cortex in the left parieto-occipital region, traversing just superolateral to the left trigone into the left thalamus and ending in the region of left cerebral peduncle and subthalamic nucleus. There was no left GPi lesion. A left GPi-DBS electrode was inserted. At 6 months' follow-up, the patient's arm was more relaxed and his spasms lessened in their severity and frequency. Although the Burke-Fahn-Marsden score of 21 had improved modestly by 20%, pain and comfort levels had significantly improved with 50% improvement in visual analog scale score, translating in better quality of life. There were no complications. The clinical benefit persists at 5 years post surgery.Selected patients with posttraumatic hemidystonia, including following penetrating head injury, represent one group of secondary dystonias that might benefit from DBS surgery.

Disruption of the Posterior Medial Network during the Acute Stage of Transient Global Amnesia: A Preliminary Study.

Acute perturbation of the corticohippocampal circuitry is a primary pathophysiological mechanism underlying transient global amnesia (TGA). With regard to memory, 2 distinct corticohippocampal circuitries potentially exist: the anterior temporal network and the posterior medial network. We used electroencephalography (EEG) spectral analysis to determine which network is disrupted during the acute stage of TGA. Patients with TGA who visited Seoul National University Bundang Hospital within 24 hours after symptom onset were retrospectively identified. Twenty patients underwent EEG twice, once in the acute stage (<24 hours after symptom onset) and once in the resolved stage (>2 months after symptom onset). A fast Fourier transform was applied to compute the spectral power of the 6 frequency bands: delta, theta, alpha, beta 1, beta 2, and gamma. We assumed that the frontocentral and temporal regions belonged to the anterior temporal network, whereas the parieto-occipital regions belonged to the posterior medial network. A paired Student's t test was used to evaluate the difference in the regional spectral powers in each frequency band between the acute and resolved TGA stages. Compared with the resolved stage, relative theta power in the left parieto-occipital region was increased and relative alpha power in the right parieto-occipital region was reduced during the acute stage of TGA, with a statistical significance of P<.05 (uncorrected). The cortical regions that belonged to the posterior medial network showed alterations of neuronal activity, which reflects disruption of the posterior medial network during the acute stage of TGA.

Lacosamide as add-on treatment of focal symptomatic epilepsy in a patient with alcoholic liver cirrhosis.

The occurrence of epileptic seizures in the presence of hepatic disease is not uncommon in clinical practice. Selecting an appropriate AED for patients affected by liver failure who have new-onset epileptic seizures can be challenging. We describe a 64-year-old man affected by liver cirrhosis. The patient developed partial epilepsy with secondary generalization because of an intracerebral hemorrhage in the left parieto-occipital regions. After the neurosurgery procedure, seizures reappeared and were initially managed with levetiracetam. After one month, the patient experienced clusters of seizures while on stable treatment with levetiracetam. Pregabalin as add-on was not tolerated; therefore, he received a low dose of phenobarbital as add-on treatment. The patient developed hepatic encephalopathy. Phenobarbital was immediately stopped, and oral lacosamide was added. A rapid recovery of encephalopathy with a 6-month seizure freedom was obtained. The patient died 6 months later because of progressive impairment of liver function. Lacosamide may represent an alternative to other AEDs in patients with liver failure; however, further prospective evaluation of its efficacy and safety in this clinical setting is needed.

REVERSIBLE LEUKOENCEPHALOPATHY AS A PRESENTATION OF CEREBRAL AMYLOID ANGIOPATHY

A 73 year old man with a past medical history of hypertension, osteoathritis and asthma presented to the local district general hospital with recurrent episodes of spontaneously resolving encephalopathy.The initial...

Angiocentric glioma: clinical, morphological, immunohistochemical and molecular features in three pediatric cases

Angiocentric glioma is a rare slow growing tumor. It is associated to seizures and is mainly diagnosed in children and young adults. We describe the clinical, histo-pathological and molecular (IDH1, IDH2 and BRAFV600E mutational status) features in 3 children, 2 girls (2- and 11-years old) and 1 boy (10-years old). The tumors were located at the left temporo-parietalinsular, left parieto-occipital and left subcortical paramedian region respectively. All 3 patients were operated. Two patients are well at 2 and 16 months of follow-up while the third still suffers from seizures at 7 years of follow-up. Histologically, all tumors were composed of spindle-shaped cells showing a prominent tendency to align around the blood vessels and to grow in the subpia space creating palisade-like structures. In one case the tumoral cells were embedded in a mucoid matrix and some microcalcifications were observed. In all the cases the neoplastic cells diffusely immunostained for GFAP and S-100. Punctate dot-like intracytoplasmic staining for EMA was also observed. All tumors resulted in wild type for the mutations investigated. Owing to the rarity of angiocentric glioma, we believe that each new case should be recorded to produce a better clinical, pathological and molecular characterization of this lesion.

Juvenile Systemic Lupus Erythematosus and Glioblastoma:A Case Report and Literature Review

This is a case report of 11-years-old Chadian female, diagnosed with juvenile systemic lupus erythematosus based on five out of eleven criteria of the American College of Rheumatology. Her disease was under control on oral prednisolone, azathioprine and hydroxychloroquine. One year after diagnosis, she presented to the emergency department complaining of severe headache, vomiting and deterioration in the level of consciousness. Urgent brain computed tomography scan showed large brain tumour in the left parietooccipital region with significant midline shifting. Craniotomy and excisional biopsy of the mass was performed by a neurosurgeon. Histopathology reports a high grade malignant glioblastoma multiforme. Three cases were reported in the literature as space occupying lesion in the brain in juvenile systemic lupus erythematosus. To our knowledge, glioblastoma multiforme is the first case to report in juvenile systemic lupus erythematosus. Thus, severe headache and unusual neurological manifestations in juvenile systemic lupus erythematosus may be related to space occupying lesion, and should be evaluated immediately for early medical and surgical management.

Decreased white matter integrity before the onset of delusions in patients with Alzheimer&amp;#39;s disease: diffusion tensor imaging

BackgroundThe pathology of delusions in patients with Alzheimer’s disease (AD) associated with white matter (WM) abnormalities is poorly understood. In addition, whether the abnormalities in WM integrity that underlie the delusions develop before the onset of the delusions remains unclear. In this study, we used a diffusion tensor imaging approach to examine the existence of baseline abnormalities in WM integrity in AD patients who developed delusions and AD patients who did not develop delusions.MethodsUsing the Neuropsychiatric Inventory, we identified patients with AD who exhibit delusions during a 1-year period. All the patients underwent a magnetic resonance imaging (MRI) examination at baseline. We conducted fractional anisotropy using tract-based spatial statistics software and compared the results of AD patients who developed delusions with those who did not develop delusions.ResultsCompared with the AD patients who did not develop delusions (n = 15), the AD patients who developed delusions (n = 10) exhibited two relatively large clusters and one minimal cluster of significantly lower fractional anisotropy results. The first cluster was located in the left parieto-occipital region and included several fibers: the left inferior longitudinal fasciculus, the inferior fronto-occipital fasciculus, the posterior corona radiate, and the forceps major of the corpus callosum. The second cluster was located on the body of the corpus callosum. A third minimal cluster was located on the superior temporal gyrus white matter.ConclusionAbnormalities in WM integrity involving several fibers may be crucial to the development of delusions in AD patients.

A 31 day old with head injury – developmental ‘milestones’ do not apply to everyone

<h3>Case history</h3> FD, a 36 week gestation well baby, presented from home after a head injury. During a nappy change, he had been positioned on a changing mat on top of a chest of drawers, one metre above a carpeted floor. He fell off the mat and was found lying on the floor, not losing consciousness. Developmentally, FD was reported to be a very active baby and parents believed he had ‘wriggled’ off the changing mat. They mentioned that FD had rolled from front to back previously. There was a boggy swelling 5 cm×8 cm in the left parieto-occipital region with no other bruising, injury or abnormality. He was not witnessed to be able to roll during initial assessment. Safeguarding protocols were followed as the mechanism of injury was not fully explained in a non-mobile infant. CT head revealed a left-sided parietal skull fracture associated with a subdural haematoma. No other parenchymal injury or stigmata of previous traumatic brain injury was seen. There were no retinal haemorrhages, other skeletal survey findings or blood test abnormalities. During his stay in hospital, the nursing and medical team witnessed (and digitally recorded) FD rolling from back to front: this is available for presentation and corroborated the parents9 history. <h3>Discussion</h3> Evidence shows that abusive and non-abusive skull fractures are commoner in younger infants and a recent meta-analysis calculated the overall probability that a skull fracture is due to abuse is 29%. Initial consensus opinion in FD9s case was that accidental head injury was very unlikely given his developmental age. This case highlights that normal developmental milestones do not apply to every child. The Denver II developmental screening test, constructed from 2,000 subjects, shows that a baby would not roll before two months. It is crucial in all cases to keep a non-judgemental attitude and be open to mechanisms of injury that seem unusual, particularly if there are Safeguarding concerns.

Limb Shaking and Orbital Bruit: Uncommon Manifestations of Severe Carotid Occlusive Disease (P05.220)

Objective: To highlight the features of limb shaking transient ischemic attacks (TIA9s), an uncommon but treatable condition. Background Since Miller Fisher9s first description of limb-shaking syndrome in 1962, there have been less than 50 such cases reported in literature. Prompt recognition of this condition is important, as treatment is needed to prevent future ischemic stroke. Cephalic auscultation can serve as an invaluable clinical clue in making this diagnosis. Design/Methods: Case report. Results: A 72 year-old woman presented for evaluation of orthostatic spells of right leg clumsiness and rhythmic flailing, resulting in falls. Initial evaluation revealed a new iron-deficiency anemia. Colonoscopy revealed a malignant-appearing mass, suspicious for primary adenocarcinoma of the colon. Her spells became more frequent after starting metoprolol. Spell frequency decreased with blood transfusions. Neurologic examination revealed a harsh right orbital bruit and a soft left cervical bruit. MRI demonstrated subacute infarction of the left parieto-occipital region. MRA revealed a critical stenosis of the proximal left internal carotid artery (ICA) and a moderate stenosis of the right ICA. She was diagnosed with right-sided limb shaking TIA9s, culminating in infarction of the watershed territory between the left middle cerebral and posterior cerebral arteries. Conclusions: Often confused with focal motor seizures, limb shaking TIA9s are an uncommon manifestation of cerebral ischemia. The distinction is critical, as this form of TIA can indicate severe carotid occlusive disease, warranting urgent revascularization. A meticulous history reveals the rhythmic activity is not associated with a Jacksonian march and is mainly precipitated by orthostatic maneuvers. An orbital bruit is often associated with either stenosis or occlusion of the ipsilateral or contralateral ICA. Orbital bruits are attributed to turbulent blood flow through the collateral intracranial system. Such a technique can help neurologists to more promptly diagnose and treat this condition, preventing future ischemic stroke. Disclosure: Dr. Morparia has nothing to disclose.

Malignant Nerve Sheath Tumor of the Spinal Accessory Nerve: A Unique Presentation of a Rare Tumor

BackgroundMalignant peripheral nerve sheath tumors (MPNSTs), sarcomas originating from tissues of mesenchymal origin, are rare in patients without a history of neurofibromatosis.Case ReportWe report a case of an MPNST of the spinal accessory nerve, unassociated with neurofibromatosis, which metastasized to the brain. The tumor, originating in the intrasternomastoid segment of the spinal accessory nerve, was removed. Two years later, the patient presented with focal neurological deficits. Radiographic findings revealed a well-defined 2.2×2.2×2.2 cm, homogeneously enhancing mass in the left parieto-occipital region of the brain surrounded by significant vasogenic edema and mass effect, culminating in a 1-cm midline shift to the right. The mass was surgically removed. The patient had nearly complete recovery of vision, speech, and memory.ConclusionsTo our knowledge, this is the first documented case of an MPNST arising from an extracranial segment of the spinal accessory nerve and metastasizing to the brain.

Eine neonatale intrazerebrale Blutung als Initialsymptom einer Gliomatosis cerebri WHO III – neurologisches Outcome nach partieller Hemisphärektomie

Anaplastic astrocytomas presenting as gliomatosis cerebri in neonates are extremely rare. Tumours in newborns are mostly of neuroectodermal origin. We report about a female newborn at term [birth weight 3 600 g (P 90), head circumference 35 cm (P 95) APGAR 9/10/10] with an intracerebral partially clotted bleeding in the left parieto-occipital region. The bleeding was expansive leading to axial and lateral cerebral herniation. The intracerebral bleeding in the left occipital region was surgically removed. Macroscopically no solid tumour was seen, but small fragments of an anaplastic astrocytic tumour (WHO grade III) were diagnosed histologically. After surgery, no remaining tumour was visible in the MRI. 6 weeks later, a recurrent tumour (4×4 cm) was found in the area of the initial bleeding. Further treatment was initially refused by the parents. The child was readmitted to our hospital at the age of 11 months in good clinical condition and presented with left-sided hemiparesis, right-sided hemianopsia and intermittent strabismus convergens alternans. Because of the good clinical condition further therapeutic treatment was initiated. Due to the final extension of the tumour into the temporal, parietal and occipital lobes, a gliomatosis cerebri WHO III was diagnosed. An extended partial hemispherectomy was done. After neurosurgery, no further neurological failures occurred. In the follow-up examination, MRI showed no relapse of the tumour. Chemotherapy according to the HIT SKK protocol was initiated. A relapse did not occur over a follow-up of 2 years. This is a rare case report of a congenital gliomatosis cerebri WHO grade III, treated with partial hemispherectomy, leading to a good clinical and neurological long-term outcome.

Primary Cerebral Myxofibrosarcoma

Herein, we describe an intracerebral primary low-grade myxofibrosarcoma occurring in a 9-year-old boy. The lesion measured 7 cm and occupied the left parieto-occipital region. A gross-total removal of the tumor was performed. Nine months later, radiologic follow-up revealed a local recurrence which was again surgically removed. The patient then underwent radiotherapy and chemotherapy. He was well and disease-free at 6 months follow-up. The tumor was composed of spindle, stellated, and multinucleated cells embedded in a myxoid background. Foci of increased cellularity, pleomorphism, and high mitotic rate were present. The tumor borders were sharply demarcated from the non-neoplastic nervous parenchyma. Immunohistochemical staining showed that the neoplastic cells were vimentine and CD34 positive. Fluorescence in-situ hybridization analyses did not show FUS and EWSR1 gene rearrangements. Primary intracranial myxofibrosarcomas are very rare (to the best of our knowledge, less than 10 published cases in the international literature). We believe each new case should be recorded to produce a better clinical, pathologic, molecular, prognostic, and therapeutic characterization of this lesion.

Vehicle-associated closed trauma-induced stroke in a 27-day-old girl

Birth trauma, but not postnatal trauma, has been recognized as a cause of cerebral infarction in newborns. We report a case of cerebral infarction in a 27-day-old girl after a car accident. During the car accident, the child was properly restrained to the child's safety seat. The patient was admitted to the hospital for observation because of pronounced irritability. There were no focal neurological symptoms on admission. Twenty-eight hours after the accident, the child developed focal tonic-clonic seizures and mild right-sided hemiparesis. The seizures were successfully treated with phenobarbital at a dose of 30 mg per day. Computed tomography and magnetic resonance imagining performed on the second and third days after the accident, respectively, showed subdural hemorrhage in the occipital regions and cerebral ischemia in the left parieto-occipital region. Control imaging 10 days later showed signs of reperfusion. Persistent child irritability after head trauma is one of the indicating factors for performing an emergency computed tomography scan of the head.

Cerebral Perfusion Changes in Hemiplegic Migraine

A 35-year-old man presented with reversible right-sided weakness and impaired verbal expression, followed by a pulsatile headache. Similar yearly attacks had occurred. Abnormally increased Tc-99m ethyl cysteinate dimer (ECD) activity in the left parieto-occipital region was noted during the phase of headache and normalized in the follow-up study. Ten months later, he had 2 episodes of left-sided numbness and headache. Tc-99m ECD during the aura phase revealed hypoperfusion at the right thalamus. Family history and genetic studies were negative, so sporadic hemiplegic migraine was concluded. Our report clearly demonstrated that Tc-99m ECD SPECT is an accurate assessment of brain perfusion changes in hemiplegic migraine.