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Meenakshi-Sundaram et al. SPECT observations in RPL syndrome

acute stroke, a focal or regional area of hypoperfusion 2. Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible
or no perfusion will be seen which is larger than the encephalopathy syndrome: utility of fluid-attenuated inversion
lesion that is later seen on CT or MRI. Brain perfusion recovery MR imaging in the detection of cortical and subcortical
SPECT patterns may predict the outcome of stroke 3. lesions. AJNR Am J Neuroradiol 2000;21:1199-206.
Tajima Y, Isonishi K, Kashiwaba T, Tashiro K. Two similar cases of
patients and thus help in the selection of candidates encephalopathy, possibly a reversible posterior leukoencephalopathy
for fibrinolytic therapy as well as decompressive syndrome: serial findings of magnetic resonance imaging, SPECT and
hemicraniectomy. [14,15] Functional imaging studies like angiography. Intern Med 1999;38:54-8.
perfusion and diffusion weighted MR imaging and MR 4. Nishigaki Y, Inoue M, Jimi T, Wakayama Y, Yoshiba M. Reversible
spectroscopy could also be utilized to detect ischemic posterior leukoencephalopathy in a patient receiving cyclosporin
changes. [16-19] Hyperintense signals are seen in areas therapy. Rinsho Shinkeigaku 1999;39:360-3. (in Japanese)
of both vasogenic edema and infarction on routine 5. Naidu K, Moodley J, Corr P, Hoffmann M. Single photon emission
T2 weighted images. However, on diffusion weighted and cerebral computerised tomographic scan and transcranial
Doppler sonographic findings in eclampsia. Br J Obstet Gynaecol
imaging, vasogenic areas demonstrate increased 1997;104:1165-72.
diffusion and cyotoxic edema seen in infarcted areas 6. Schwartz RB, Jones KM, Kalina P, Bajakian RL, Mantello MT,
demonstrate decreased diffusion. In our patient Garada B, Holman BL. Hypertensive encephalopathy: findings on CT,
repeat MR imaging revealed resolution of the lesions MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol
suggesting reversible ischemia rather than established 1992;159:379-83.
infarct. Thus it is understandable that functional 7. Strandgaard S, Paulson OB. Cerebral autoregulation. Stroke
studies like SPECT may enhance the understanding 1984;15:413-6.
of the extent and nature of the lesions typical of the 8. Dougall NJ, Bruggink S, Ebmeier KP. Systematic review of the
diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia. Am J
syndrome. Follow up SPECT study however could not Geriatr Psychiatry 2004;12:554-70.
be done in the patient. 9. Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, Thornton J,
van Lierop M, Cohen P, Amen DG, Henderson T. Clinical utility of
In conclusion, SPECT findings in our patient SPECT neuroimaging in the diagnosis and treatment of traumatic
with RPL syndrome correlated positively with the brain injury: a systematic review. PLoS One 2014;9:e91088.
presented clinical deficits: advantage of SPECT 10. Prichard JW, Brass LM. New anatomical and functional imaging
study over routine MRI is its good correlation with methods. Ann Neurol 1992;32:395-400.
clinical abnormalities. MRI abnormalities, in contrast 11. Koch S, Rabinstein A, Falcone S, Forteza A. Diffusion-weighted
imaging shows cytotoxic and vasogenic edema in eclampsia. AJNR
to SPECT findings, are extensive and poorly Am J Neuroradiol 2001;22:1068-70.
correlate with clinical deficits. Thus SPECT may be 12. Reivich M. Crossed cerebellar diaschisis. AJNR Am J Neuroradiol
an invaluable tool to understand the morphological 1992;13:62-4.
and functional changes in RPL syndrome. 13. Alavi A, Hirsch LJ. Studies of central nervous system disorders with
single photon emission computer tomography and positron emission
Financial support and sponsorship tomography: evolution over the past 2 decades. Semin Nucl Med
None. 1991;21:58-81.
14. Bhattarai S, Ning ZX, Tuerxun T. EEG and SPECT Changes in acute
ischemic stroke. J Neurol Neurophysiol 2014;5:190.
Conflicts of interest 15. Masdeu JC, Arbizu J. Brain single photon emission computed
There are no conflicts of interest. tomography: technological aspects and clinical applications. Semin
Neurol 2008;28:423-34.
Patient consent 16. Brubaker LM, Smith JK, Lee YZ, Lin W, Castillo M. Hemodynamic
Patient consent was obtained from the patient. and permeability changes in posterior reversible encephalopathy
syndrome measured by dynamic susceptibility perfusion-weighted
Ethics approval MR imaging. AJNR Am J Neuroradiol 2005;26:825-30.
Data collection in our study involving the patient is 17. Schaefer PW, Buonanno FS, Gonzalez RG, Schwamm LH. Diffusion-
consistent with the ethical standards of the institution’s Weighted Imaging discriminates between cytotoxic and vasogenic
edema in a patient with eclampsia. Stroke 1997;28:1082-5.
ethics committee. 18. Russell MT, Nassif AS, Cacayorin ED, Awwad E, Perman W, Dunphy
F. Gemcitabine-associated posterior reversible encephalopathy
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32 Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ February 20, 2017