[Show abstract][Hide abstract] ABSTRACT: Assessment of cerebral perfusion on patients with subarachnoid haemorrhage (SAH) in the Neurologic Intensive Care Unit is difficult since nuclear medicine imaging modalities capable of measuring cerebral blood flow (CBF) are not generally available. We performed 101 quantitative (ml 100g-min) bedside CBF measurements on 40 individual patients to correlate SAH grade with CBF and to assess the effect of surgical intervention on CBF. Global CBF (G-CBF) and bihemispheric CBF (B-CBF) asymmetry were correlated with the grade of SAH pre- and post-operatively. Data analysis showed that pre-operative patients with low grade SAH (Hunt and Hess grades 0 to 2) had higher mean G-CBF values [44.2 +/- 71] than those with high grade SAH (Hunt and Hess grades 3 to 4): [mean G-CBF = 34.1 +/- 1.7]. Post-surgery there was a significant improvement in G-CBF; CBF increased [5.3 +/- 1.07] in the group of patients with low grade SAH. Patients with high grade SAH showed no significant improvement in their G-CBF during the first week post-operatively compared to pre-operative values. We conclude that portable units capable of measuring bedside CBF values are useful in monitoring CBF changes in patients with SAH. Patients with low grade SAH have G-CBF within normal limits both pre-operatively and post-operatively, with a statistically significant increase in CBF during two weeks post-operatively. Patients with high grade SAH show no significant increase in CBF one week post-operatively compared to their pre-operative measures.
[Show abstract][Hide abstract] ABSTRACT: Bone imaging of the body is often requested to rule out metastatic disease. A patient with suspected breast carcinoma underwent bone imaging which revealed a focal area of uptake that appeared to be localized in the right posterior calvarium. The initial interpretation was possible solitary metastatic breast carcinoma to the skull. Skull radiographs and head computed tomography (CT) were suggested for follow-up evaluation. The skull series was performed immediately after bone imaging and was negative. Further clinical information revealed that the patient recently had undergone total right internal carotid artery ligation for treatment of a large, surgically inaccessible right cavernous aneurysm. SPECT imaging of the head localized the region of abnormal uptake adjacent to the calvarium, which suggested the uptake was due to a recent brain infarction or metastatic disease to the brain. A CT scan performed 4 days later demonstrated generalized cerebral atrophy, but was otherwise normal, ruling out metastatic breast carcinoma. This case emphasizes the importance of SPECT imaging when a solitary skull lesion is found on bone imaging. SPECT can localize the lesion to be within the brain and/or skull and can aid in further investigative management. A lesion located at the periphery of the brain may be due to an occult stroke. This finding is of particular consideration in the elderly in whom there is a relatively high incidence of coexisting cancer and silent brain infarction.
Clinical Nuclear Medicine 08/1988; 13(7):498-501. DOI:10.1097/00003072-198807000-00005 · 3.93 Impact Factor