Sagiuchi T, Ishii K, Asano Y, Aoki Y, Woodhams R, Yanaihara H, Kan S, Hayakawa K
Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Ann Nucl Med. 2001 Jun;15(3):267-70. doi: 10.1007/BF02987844.
Cerebral perfusion single photon emission computed tomography (SPECT) has been used to confirm the localization of the epileptic focus and the evaluation of seizure. Recently, diffusion-weighted MR imaging (DWI) has been recognized for evaluation of seizure activity. We describe a case of transient seizure activity demonstrated by Tc-99m HMPAO SPECT and DWI. This patient was a 61-year-old woman with a 10-month history of right middle cerebral artery (MCA) infarction who had a generalized seizure during MRI. DWI immediately after seizure showed transient hyperintensity in the right frontal gray matter and the white matter, and these apparent diffusion coefficients (ADC) were transiently decreased. This transient hyperintensity on DWI corresponded to transient hyperperfusion identifying the epileptic focus on interictal Tc-99m HMPAO SPECT. Transient sustained seizure activity might cause these changes on DWI and SPECT. It was considered that interictal Tc-99m HMPAO SPECT showed the delayed hyperperfusion caused by excitatory neuronal overaction and DWI showed cytotoxic edema seizure-induced by energy failure of the membrane-bound Na/K-ATPase pump.
脑灌注单光子发射计算机断层扫描（SPECT）已被用于确定癫痫病灶的位置以及评估癫痫发作。近来，弥散加权磁共振成像（DWI）在评估癫痫活动方面得到了认可。我们描述了一例通过锝-99m六甲基丙烯胺肟（Tc-99m HMPAO）SPECT和DWI显示的短暂癫痫活动病例。该患者为一名61岁女性，有右侧大脑中动脉（MCA）梗死10个月病史，在磁共振成像（MRI）期间发生了全身性癫痫发作。癫痫发作后即刻的DWI显示右侧额叶灰质和白质有短暂高信号，且这些表观扩散系数（ADC）短暂降低。DWI上的这种短暂高信号对应于发作间期Tc-99m HMPAO SPECT上确定癫痫病灶的短暂高灌注。短暂持续性癫痫活动可能导致DWI和SPECT出现这些变化。据认为，发作间期Tc-99m HMPAO SPECT显示的是由兴奋性神经元过度活动引起的延迟性高灌注，而DWI显示的是由膜结合钠/钾-ATP酶泵能量衰竭导致的细胞毒性水肿性癫痫发作。
