Citak Elvan Caglar, Gücüyener Kivilcim, Karabacak Nese Ilgin, Serdaroğlu Ayşe, Okuyaz Cetin, Aydin Kurşad
Department of Pediatric Neurology, Gazi University Medical Faculty, Ankara, Turkey.
J Child Neurol. 2004 May;19(5):387-90. doi: 10.1177/088307380401900513.
Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions.
A组链球菌感染可引发多种神经精神障碍，如 Sydenham 舞蹈病、抽动症、强迫症以及与链球菌感染相关的小儿自身免疫性神经精神障碍（PANDAS）。对 Sydenham 舞蹈病患者进行的结构成像（计算机断层扫描和磁共振成像）和功能成像（正电子发射断层扫描、单光子发射计算机断层扫描）研究表明，纹状体存在可逆性异常。本研究的目的是利用六甲基丙烯胺肟单光子发射计算机断层扫描（HMPAO-SPECT），对7例 Sydenham 舞蹈病患者和2例链球菌性抽动障碍患者的皮质下结构脑灌注模式进行研究。HMPAO-SPECT 研究显示，2例舞蹈病患者呈现高灌注模式，5例呈现低灌注模式，2例抽动障碍患者也呈现低灌注模式。结合症状的持续时间、严重程度以及治疗反应对结果进行了讨论。在 Sydenham 舞蹈病中，功能成像结果可能存在差异，纹状体和丘脑的高灌注可能是治疗反应和症状严重程度的一个指标。然而，目前通过 SPECT 或正电子发射断层扫描研究的病例数量仍然太少，无法得出任何确凿结论。
