Posterior cerebral artery Wada test: sodium amytal distribution and functional deficits.
Inadequate sodium amytal delivery to the posterior hippocampus during the intracarotid Wada test has led to development of selective tests. Our purpose was to show the sodium amytal distribution in the posterior cerebral artery (PCA) Wada test and to relate it to functional deficits during the test. We simultaneously injected 80 mg sodium amytal and 14.8 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO) into the P2-segment of the PCA in 14 patients with temporal lobe epilepsy. To show the skull, we injected 116 MBq 99mTc-HDP intravenously. Sodium amytal distribution was determined by high-resolution single-photon emission computed tomography (SPECT). In all patients, HMPAO was distributed throughout the parahippocampal gyrus and hippocampus; it was also seen in the occipital lobe in all cases and in the thalamus in 11. Eleven patients were awake and cooperative; one was slightly uncooperative due to speech comprehension difficulties and perseveration. All patients showed contralateral hemianopia during the test. Four patients had nominal dysphasia for 1-3 min. None developed motor deficits or had permanent neurological deficits. Neurological deficits due to inactivation of extrahippocampal areas thus do not grossly interfere with neuropsychological testing during the test.
Urbach
H
H
Department of Radiology/Neuroradiology, University of Bonn, Sigmund Freud-Str. 25, 53105 Bonn, Germany. urbach@uni-bonn.de
Klemm
E
E
Linke
D B
DB
Behrends
K
K
Biersack
H J
HJ
Schramm
J
J
Schild
H H
HH
D000328:Adult; D000654:Amobarbital / Q000008:administration & dosage / Q000494:pharmacology; D001037:Aphasia / Q000139:chemically induced; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006423:Hemianopsia / Q000139:chemically induced; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008568:Memory / Q000187:drug effects; D008569:Memory Disorders / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D020769:Posterior Cerebral Artery; D011183:Postoperative Complications; D011597:Psychomotor Performance / Q000187:drug effects; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D000654:Amobarbital