Indian Journal of Nuclear Medicine
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CASE REPORT
Year : 2018  |  Volume : 33  |  Issue : 2  |  Page : 154-157

Mismatch in Brain Perfusion and Metabolism Detected with 99mTc-Hexamethyl Propylene Amine Oxime Single Photon Emission Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography in Moyamoya Disease


Department of Nuclear Medicine, Infanta Cristina Hospital, Badajoz, Spain

Correspondence Address:
Dr. Justo Serrano Vicente
Hospital Infanta Cristina de Badajoz, Avda. Elvas SN. 06010, Badajoz
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_2_18

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We report a 47-year-old woman who developed an ischemic stroke with diplopia and dysarthria. Emergency computed tomography (CT) showed no pathological findings, and magnetic resonance (MR) showed mild ischemic-degenerative lesions. MR angiography and angiogram showed severe stenosis of both internal carotid and main intracranial arteries with plenty collateral vessels with “puff of smoke” suggesting a moyamoya disease (MMD). Brain perfusion single-photon emission CT showed global diminished perfusion in the brain lobes and a marked relative hyperperfusion in the cerebellum. However, brain 18F-fluorodeoxyglucose-positron emission tomography showed physiological metabolism in the brain cortex with only slightly relative cerebellar hypermetabolism. MMD is a well-known arterial pathology that frequently develops with only mild symptoms until the middle age. Functional neuroimaging findings indicate a mismatch between brain glucose metabolism and brain perfusion, probably due to neuronal subclinical chronic ischemia in the brain cortex with preserved viability of neurons.


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