(99m)Tc-TRODAT-1 and (123)I-IBZM SPECT studies in a patient with extrapontine myelinolysis with parkinsonian features.
Osmotic demyelination syndrome can result from the rapid correction of hyponatremia, and is categorized by central pontine myelinolysis and extrapontine myelinolysis (EPM). Magnetic resonance imaging (MRI) is currently the most useful modality for visualizing EPM lesions. However, MRI is unable to delineate the severity of involvement in the nigrostriatal dopaminergic pathway. The authors describe the case of a 48-year-old woman who developed isolated EPM with predominantly right-sided parkinsonian symptoms after rapid correction of hyponatremia. MRI revealed symmetrical demyelinating lesions in the bilateral striatum without central pontine involvement. (99m)Tc-TRODAT-1 and (123)I-iodobenzamide ((123)I-IBZM) single-photon emission computed tomography (SPECT) images showed unequally decreased uptake in the bilateral striatum. Treatment with carbidopa/levodopa improved the clinical parkinsonian symptoms. (99m)T(C)-TRODAT-1 and (123)I-IBZM SPECT images provide presynaptic and postsynaptic molecular information of the nigrostriatal dopaminergic pathway. The lesions demonstrated in the (99m)T(C)-TRODAT-1 and (123)I-IBZM SPECT images show higher correlation with the severity of clinical features in EPM than MRI, and the modalities may be useful in the evaluation of patients with parkinsonian symptoms.
Wu
Yi-Chung
YC
Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan, ROC.
Peng
Giia-Sheun
GS
Cheng
Chun-An
CA
Lin
Chun-Chieh
CC
Huang
Wen-Sheng
WS
Hsueh
Chun-Jen
CJ
Lee
Jiunn-Tay
JT
D001549:Benzamides / Q000378:metabolism; D004298:Dopamine / Q000378:metabolism; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000378:metabolism; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000150:complications* / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D015609:Organotechnetium Compounds / Q000378:metabolism; D020734:Parkinsonian Disorders / Q000150:complications* / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D011759:Pyrrolidines / Q000378:metabolism; D013378:Substantia Nigra / Q000378:metabolism; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes / Q000378:metabolism
D001549:Benzamides; D015609:Organotechnetium Compounds; D011759:Pyrrolidines; D014326:Tropanes; C104196:technetium Tc 99m TRODAT-1; C055743:3-iodo-2-hydroxy-6-methoxy-N-((1-ethyl-2-pyrrolidinyl)methyl)benzamide; D004298:Dopamine