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P35-3 Anatomofunctional assessment of silent brain damage in asymptomatic hypertensive patients
29th International Congress of Clinical Neurophysiology P34-25 Comparison of post-exercise exhaustion (PEE) in myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) S.J. Oh1 , F. Kizlay2 , Y. Hatanaka3 1 Neurology Department, University of Alabama at Birmingham, Birmingham, Alabama, USA, 2 Department of Neurology, Faculty of Medicine, Andez University, Antalya, Turkey, 3 Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan Objectives: Post-exercise exhaustion (PEE) was not systematically studied in MG and LEMS. This study is to compare the post-exercise facilitation (PEF) and post-exercise exhaustion (PEE) phenomenon in MG and LEMS. Methods and Materials: The 3 Hz repetitive nerve stimulation (RNS) tests were performed in the abductor digiti quinti muscle at the rest, 0 second (s) (PE0s), 30 s, 1 minute (m), 2 m, 3 m and 4 m after the 10 s exercise. The CMAP amplitude and decremental response were measured. Findings were compared with 13 normal individuals, 8 LEMS patients, and 34 MG patients. Results: In 32 tests in 16 normal controls, there is no significant difference in the CMAP amplitude and the decrement at PE0s and 30s as well as PE 1m, 2m, 3m and 4m. Decrement at 3 Hz stimulation was less than 6% in normal control. LEMS: In 18 tests in 8 patients, PEF by amplitude (PEF-A) and PEF by decrement (PEF-D) was observed at PE0, showing an improvement (+261%). A mild PEF-A (+27%) was still observed at PE30s but it was normalized to the pre-test level at PE1m. A significant decrement was worst ( 52%) at PE2m. Thus PEE-D was noted at 2 minutes after exercise. MG: In 34 tests in 34 patients, there was no CMAP change in the CMAP amplitude in the serial tests. There was PEF-D but no PEF-A at PE0. Non-significant PEE-D ( 10%) was observed at PE2m. A significant PEE-D ( 13%) was noted at PE4m only with one minute exercise. Conclusions: There is a distinct difference in PEE between MG and LEMS. P34-26 Autonomic nervous system manifestations and skin sympathetic response findings in Lambert-Eaton syndrome Y. Guan1 1 Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China Objectives: The authors examined the symptoms and signs of autonomic nervous system of Lambert-Eaton myasthenic syndrome (LEMS) in fortyfive patients using retrospecive analysis to analyze clinical manifestations of autonomic nervous system and Skin Sympathetic Response (SSR) characters in LEMS. Methods: Forty-five LEMS patients’ records were reviewed and informations gathered regarding clinical complains and signs of autonomic nervous system. SSR results and other autonomic examinations data were collected. Results: The authors identified the following three findings: (1) The most first common symptom was weakness of lower extremities (n = 35) and the most common symptoms of autonomic nervous system was dry mouth (n = 19) and constipation (n = 21), which could be occured before the onset of the legs. (2) Cardiovascular system dysfunctions were found in 4 patients: 1 bradycardia, 1 postural hypotension, 2 tachycardia. Secretory glands dysfunctions were found in 30 patients: 19 dry mouth, 5 dry eyes, sweating dysfunctions in 8 patients. 25 patients complained of alimentary dysfunctions including constipation and diarrhea. Bladder dysfunctions were found in 2 patients, who complained of urinary inconstinence. 7 male patients complained of male sexual impotence. Abnormal skin scratch test were found in 13 patients. (3) SSR were undergoing in 25 patients and 13 found abnormal. Conclusions: Autonomic nervous system manifestations were popular and prominent in Lambert-Eaton patients. SSR was sensitive and special in LEMS. More electrophysiology tests need in LEMS patients.
S311 P35. Cerebrovascular diseases P35-1 Application of neuronal activity topography to vascular cognitive impairment with carotid artery stenosis T. Shibata1 , Y. Horie1 , N. Hayashi2 , S. Endo2 , T. Musha3 , H. Matsuzaki3 1 Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan, 2 Department of Neurosurgery, Toyama University, Toyama, Japan, 3 Brain Functions Laboratory, Inc., Japan Background and Purpose: Vascular cognitive impairment (VCI) in patients with carotid stenosis has been detected through regional neuronal abnormal activities which are displayed on a brain surface by means of a newly developed imaging technique ‘Neuronal Activity Topography (NAT)’. Material and Method: We examined 15 patients in VCI with carotid stenosis. NAT calculates z score of normalized EEG power variance (NPV) with 21 electrodes arranged according to the 10 20 method for 5 min at sampling rate of 200 Hz. A subject stays in a rest state with closed eyes. We have prepared a template set of z-scores for VCI averaged across 15 VCI, and a correlation coefficient of an observed set of z-scores is taken as a marker of a likelihood of the patient to be in VCI. Conclusion: The likelihood thus defined gives satisfactory results and conclusively NAT is a simple and non-invasive tool to identify VCI with carotid stenosis. P35-2 Clarification of recovery mechanism from chronic brain dysfunction and application to treatment EEG spectrum analysis of brain function F. Ishizaki1 , T. Harada2 , S. Aoi1 , H. Ikeda1 , C. Chikamura1 1 Faculty of Health and Welfare, Prefectural University of Hiroshima, Japan, 2 Department of Health Services Management, Hiroshima International University, Japan Objective: Although the recovery from chronic brain-dysfunction can occur, the mechanisms of the underlying restorative process remain unclear. We examined the recovering mechanisms of the brain function in the patients with stroke of a chronic period. Methods: Subjects were 30 patients (mean age when it inspected first time was 61.2 years old; on average 20.9 months post stroke). While evaluating the clinical neurological findings, the effect and the recovery process of rehabilitation were evaluated by EEG spectrum analysis. Studies of EEG by electroencephalograph SYNAFIT 2514(NEC) were examined 3.9 times on the average during 52.6 months. Results: In the EEG, although slow-wave elements were distributed in the both sides of the brain at an initial measurement, the frequency of the appearance of slow-wave elements was high on the lesion side of the brain. As progress goes on, the distribution of the slow-wave elements on a healthy side had been decreased and alpha-wave element had been gradually appeared. Improved-EEG pattern related to the good outcome of the clinical prognosis. Conclusion: It was speculated that activating a healthy side of the brain is necessary for the recovery of the brain function. Also, the devised rehabilitation for each patient is necessary for the recovery of the brain function. P35-3 Anatomofunctional assessment of silent brain damage in asymptomatic hypertensive patients M. Brown1 , Y. Valdes2 , E. Gonzalez2 , G. Hernandez1 , P. Valdes-Sosa1 , A. Berazain3 1 Neuroscience Center of Cuba, 2 University Hospital “Calixto Garcia”, 3 Institute of Neurology and Neurosurgery, Cuba Background: Several works have show abnormal electroencephalogram (EEG) in hypertensive patiens, but little are known about the anatomopatologic support of this changes. Objective: In the present study we examined the associations between initial cerebrovascular lesions and EEG abnormalities using the Grand Total EEG score (GET). Methods: MRI (0.35 Tesla, T1, T2, FLAIR) and conventional EEG were obtained from 49 asymptomatic hypertensive, 25 female and 24 male. Patients were divided into 3 MRI categories, group 1, without cerebrovascular lesion, group 2, with minimal changes, and group 3,
S312 with ischemic lesions. Differences in mean GTE were analyzed using non parametric test. Results: Although group 3 shows higher mean GET score (4.57) than group 1 (3.33) and 2 (2.50), this do not met statistical significant differences (p = 0.05). Conclusions: The GTE score is a simple EEG scoring method that could be helpful in the screening of silent cerebrovascular damage of hypertensive patients. Future investigations should be done to explore the influence of covariates. P35-4 Prognostic clinical value of delta activity in unaffected hemisphere of acute stroke patients: an EEG study G. Assenza1 , F. Zappasodi2 , F. Tecchio3,5 , M. Ercolani4 , F. Vernieri1 , P.M. Rossini1,3,4 1 Clinical Neurology, Campus Bio-Medico University, Rome, Italy, 2 Department of Clinical Sciences and Bioimaging, G. D’Annunzio University, Chieti, Italy, 3 Casa di Cura SAN RAFFAELE Cassino e IRCCS SAN RAFFAELE PISANA, Italy, 4 AFaR Dipartimento di Neuroscienze, Ospedale Fatebenefratelli, Isola Tiberina Roma, Italy, 5 Istituto di Scienze e Tecnologie della Cognizione (ISTC), CNR, Roma, Italy Background: In acute stroke patients, electroencephalographic (EEG) and magnetoencephalographic (MEG) studies demonstrated an increase in the delta band power (DBP) not only in the perilesional area, but also in the unaffected hemisphere (UH). MEG studies also demonstrated a clinical prognostic value of UH delta activity. We aim to confirm the prognostic value and the pathophysiology of UH DBP with EEG in acute stroke patients. Material and Methods: 20 patients affected by stroke in the territory of middle cerebral artery underwent 19-channels-EEG within the first week following the symptom onset. MRI lesion site and volume, NIH Stroke Scale (NIHSS) and Barthel index (BI) were also recorded. EEG recordings from 20 age- and gender-matched healthy subjects were collected. Clinical scales were also repeated after six months. Band powers in frontopolar (FR1), frontal (FR2), central (C), temporal (T), anterior parietal (P1), posterior parietal (P2) and occipital (O) region were assessed by sLORETA. Interhemispheric coherences between homologous regions were also computed by sLORETA on bipolar channels. Results: Both total and regional DBP (FR1, FR2, C, T, P1, P2, O) in affected hemisphere (AH) and UH were higher (p < 0.05) than in controls save in O region (p > 0.05). No differences were observed in total and regional DBP between the two hemispheres.AH total and FR1, FR2, C, T, P1, P2 DBP correlated with NIHSS (rho > 0.52, p < 0.05), BI (rho > 0.51, p < 0.05), and lesion size (rho > 0.53, p < 0.05). In the UH only FR1, FR2 and C correlated with NIHSS (rho = 0.544; p = 0.020; rho = 0.520; p = 0.03; rho = 0.471; p = 0.050), BI (rho = 0.76, p = 0.0001; rho = 0.66, p = 0.003; rho = 0.59, p = 0.011), and with lesion volume (FR1, rho = 0.53, p = 0.21). UH DBP in FR1, FR2 and C also correlated with clinical recovery after six months (rho = 0.69, p = 0.002; rho = 0.63, p = 0.007; rho = 0.55, p = 0.022). Discussion: Our data corroborate the prognostic clinical value of unaffected hemisphere delta power via EEG recordings focusing on the unaffected hemisphere as an additional target for neurorehabilitation procedures. P35-5 Poststroke aphasia: evaluation of cerebral hemodynamic changes with transcranial color Doppler sonography A. Arsovska1 , A. Popovski1 , Z. Arsovski2 1 University Clinic of Neurology, Skopje, Macedonia, 2 Private Neuropsychiatry Practice ‘A. Popovski’, Skopje, Macedonia, 3 University Clinic of Pulmonology and Allergy, Skopje, Macedonia Background: Transcranial color Doppler sonography (TCD) is a noninvasive method that allows detection of the hemodynamic changes in the basal cerebral arteries related to functional neuronal changes. Aim: To evaluate the cerebral hemodynamic changes and hemispheric activation during linguistic tasks and mental activity with TCD in patients with aphasia after ischemic stroke. Material and Method: We measured hemodynamic parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), mean flow velocity (MFV)) in the middle cerebral arteries (MCAs) during language naming and object recognition tasks in 30 patients and 10 healthy control subjects. The first TCD examination was made 7 14 days after the stroke onset. Two months afterwards a control TCD was performed.
Posters Results: PSV, EDV and MFV in the left MCA were much lower in aphasia patients compared to the healthy subjects (p < 0.05) during the first TCD examination. Patients with aphasia had higher blood flow shift towards the left side during linguistic tasks (p < 0.05). On the control examination, 14 (46.6%) patients who had improved linguistic skills had higher blood flow velocities in the left side (p < 0.05). These subgroup of patients had also higher blood velocity in the right MCA during the first and control TCD examination compared to the rest of the patients with aphasia and poor linguistic abilities (p < 0.05). Conclusions: TCD can non-invasively evaluate hemodynamic changes in patients with aphasia and serve as a tool to analyze the correlation between blood flow velocity and prognosis of aphasia. P35-6 Quantitative assessment of cerebral hemodynamics in a adult moyamoya disease: evaluation with acetazolamide challenged perfusion CT and SPECT imaging K.D. Jo1 , J.H. Lee2 , S.H. You3 Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 2 Department of Diagnostic Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 3 Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea 1
Objectives: Quantitative comparison of single photon emission computerized tomography (SPECT) with perfusion CT (PCT) imaging has been rarely reported in patients with moyamoya disease. We describe quantitative cerebral hemodynamics measured by acetazolamide challenged dynamic PCT and SPECT imaging in a case of moyamoya disease. Case: A 43-year-old woman presented with frequent attacks of transient right hemiparesis. Cerebral angiography showed total occlusion of the bilateral supraclinoid internal carotid arteries (ICA) with fine basal moyamoya vessels. Brain PCT showed significant decrease in regional CBF [rCBF, anterior cerebral artery (ACA, 64.8), middle cerebral artery (MCA, 77.7), and posterior cerebral artery (PCA, 115.78)] and delay of mean transient time [MTT, ACA (5.06), MCA (4.38), and PCA (1.66)] in the bilateral ICA territories. Brain CTP after infusion of acetazolamide showed more prolonged MTT in the bilateral ICA territories compared to the bilateral PCA territories and rCBF values increased in the bilateral PCA territories but decreased in the bilateral ICA territories. The Cerebral vascular reserve (CVR) capacity decreased in the bilateral ACA ( 0.34%) and MCA ( 0.54%) territories but increased in the bilateral PCA (17.9%) territories. These findings are interpreted as evidence of severe hemodynamic impairment in the bilateral ICA territories. QuantitativeSPECT image showed mild decreased CBF in the bilateral PCA (74.3) territories compared to the bilateral ICA [ACA (88.2) and MCA (81.8)] territories. Increased CVR capacity was observed in the bilateral ACA (83.9%) and MCA (119.7%) territories than in the bilateral PCA (66.7%) territories after infusion of acetazolamide. Conclusion: Cerebral PCT confirmed significant decrease in rCBF and delay of MTT in the bilateral ICA territories. The CVR capacity was impaired with PCT but increased with SPECT imaging studies in the bilateral ICA territories. This case suggests that further comparison studies between PCT and SPECT are needed for accurately measure CBF in patients with moyamoya disease. P35-7 Cerebral hemodynamics in patients with moyamoya syndrome associated with atherosclerotic occlusion of the middle cerebral arteries K.D. Jo1 , J.H. Lee2 , S.H. You3 1 Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 2 Department of Diagnostic Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 3 Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea Objectives: Patients with moyamoya disease usually present with cerebral ischemic symptoms, which are most closely related to disturbed cerebral hemodynamics, and patients with moyamoya syndrome associated with atherosclerotic occlusion also sometimes display angiographic features similar to those of moyamoya disease. The hemodynamic backgrounds of the moyamoya syndrome associated with atherosclerosis have not yet been investigated. We aimed to determine the cerebral
S311 P35. Cerebrovascular diseases P35-1 Application of neuronal activity topography to vascular cognitive impairment with carotid artery stenosis T. Shibata1 , Y. Horie1 , N. Hayashi2 , S. Endo2 , T. Musha3 , H. Matsuzaki3 1 Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan, 2 Department of Neurosurgery, Toyama University, Toyama, Japan, 3 Brain Functions Laboratory, Inc., Japan Background and Purpose: Vascular cognitive impairment (VCI) in patients with carotid stenosis has been detected through regional neuronal abnormal activities which are displayed on a brain surface by means of a newly developed imaging technique ‘Neuronal Activity Topography (NAT)’. Material and Method: We examined 15 patients in VCI with carotid stenosis. NAT calculates z score of normalized EEG power variance (NPV) with 21 electrodes arranged according to the 10 20 method for 5 min at sampling rate of 200 Hz. A subject stays in a rest state with closed eyes. We have prepared a template set of z-scores for VCI averaged across 15 VCI, and a correlation coefficient of an observed set of z-scores is taken as a marker of a likelihood of the patient to be in VCI. Conclusion: The likelihood thus defined gives satisfactory results and conclusively NAT is a simple and non-invasive tool to identify VCI with carotid stenosis. P35-2 Clarification of recovery mechanism from chronic brain dysfunction and application to treatment EEG spectrum analysis of brain function F. Ishizaki1 , T. Harada2 , S. Aoi1 , H. Ikeda1 , C. Chikamura1 1 Faculty of Health and Welfare, Prefectural University of Hiroshima, Japan, 2 Department of Health Services Management, Hiroshima International University, Japan Objective: Although the recovery from chronic brain-dysfunction can occur, the mechanisms of the underlying restorative process remain unclear. We examined the recovering mechanisms of the brain function in the patients with stroke of a chronic period. Methods: Subjects were 30 patients (mean age when it inspected first time was 61.2 years old; on average 20.9 months post stroke). While evaluating the clinical neurological findings, the effect and the recovery process of rehabilitation were evaluated by EEG spectrum analysis. Studies of EEG by electroencephalograph SYNAFIT 2514(NEC) were examined 3.9 times on the average during 52.6 months. Results: In the EEG, although slow-wave elements were distributed in the both sides of the brain at an initial measurement, the frequency of the appearance of slow-wave elements was high on the lesion side of the brain. As progress goes on, the distribution of the slow-wave elements on a healthy side had been decreased and alpha-wave element had been gradually appeared. Improved-EEG pattern related to the good outcome of the clinical prognosis. Conclusion: It was speculated that activating a healthy side of the brain is necessary for the recovery of the brain function. Also, the devised rehabilitation for each patient is necessary for the recovery of the brain function. P35-3 Anatomofunctional assessment of silent brain damage in asymptomatic hypertensive patients M. Brown1 , Y. Valdes2 , E. Gonzalez2 , G. Hernandez1 , P. Valdes-Sosa1 , A. Berazain3 1 Neuroscience Center of Cuba, 2 University Hospital “Calixto Garcia”, 3 Institute of Neurology and Neurosurgery, Cuba Background: Several works have show abnormal electroencephalogram (EEG) in hypertensive patiens, but little are known about the anatomopatologic support of this changes. Objective: In the present study we examined the associations between initial cerebrovascular lesions and EEG abnormalities using the Grand Total EEG score (GET). Methods: MRI (0.35 Tesla, T1, T2, FLAIR) and conventional EEG were obtained from 49 asymptomatic hypertensive, 25 female and 24 male. Patients were divided into 3 MRI categories, group 1, without cerebrovascular lesion, group 2, with minimal changes, and group 3,
S312 with ischemic lesions. Differences in mean GTE were analyzed using non parametric test. Results: Although group 3 shows higher mean GET score (4.57) than group 1 (3.33) and 2 (2.50), this do not met statistical significant differences (p = 0.05). Conclusions: The GTE score is a simple EEG scoring method that could be helpful in the screening of silent cerebrovascular damage of hypertensive patients. Future investigations should be done to explore the influence of covariates. P35-4 Prognostic clinical value of delta activity in unaffected hemisphere of acute stroke patients: an EEG study G. Assenza1 , F. Zappasodi2 , F. Tecchio3,5 , M. Ercolani4 , F. Vernieri1 , P.M. Rossini1,3,4 1 Clinical Neurology, Campus Bio-Medico University, Rome, Italy, 2 Department of Clinical Sciences and Bioimaging, G. D’Annunzio University, Chieti, Italy, 3 Casa di Cura SAN RAFFAELE Cassino e IRCCS SAN RAFFAELE PISANA, Italy, 4 AFaR Dipartimento di Neuroscienze, Ospedale Fatebenefratelli, Isola Tiberina Roma, Italy, 5 Istituto di Scienze e Tecnologie della Cognizione (ISTC), CNR, Roma, Italy Background: In acute stroke patients, electroencephalographic (EEG) and magnetoencephalographic (MEG) studies demonstrated an increase in the delta band power (DBP) not only in the perilesional area, but also in the unaffected hemisphere (UH). MEG studies also demonstrated a clinical prognostic value of UH delta activity. We aim to confirm the prognostic value and the pathophysiology of UH DBP with EEG in acute stroke patients. Material and Methods: 20 patients affected by stroke in the territory of middle cerebral artery underwent 19-channels-EEG within the first week following the symptom onset. MRI lesion site and volume, NIH Stroke Scale (NIHSS) and Barthel index (BI) were also recorded. EEG recordings from 20 age- and gender-matched healthy subjects were collected. Clinical scales were also repeated after six months. Band powers in frontopolar (FR1), frontal (FR2), central (C), temporal (T), anterior parietal (P1), posterior parietal (P2) and occipital (O) region were assessed by sLORETA. Interhemispheric coherences between homologous regions were also computed by sLORETA on bipolar channels. Results: Both total and regional DBP (FR1, FR2, C, T, P1, P2, O) in affected hemisphere (AH) and UH were higher (p < 0.05) than in controls save in O region (p > 0.05). No differences were observed in total and regional DBP between the two hemispheres.AH total and FR1, FR2, C, T, P1, P2 DBP correlated with NIHSS (rho > 0.52, p < 0.05), BI (rho > 0.51, p < 0.05), and lesion size (rho > 0.53, p < 0.05). In the UH only FR1, FR2 and C correlated with NIHSS (rho = 0.544; p = 0.020; rho = 0.520; p = 0.03; rho = 0.471; p = 0.050), BI (rho = 0.76, p = 0.0001; rho = 0.66, p = 0.003; rho = 0.59, p = 0.011), and with lesion volume (FR1, rho = 0.53, p = 0.21). UH DBP in FR1, FR2 and C also correlated with clinical recovery after six months (rho = 0.69, p = 0.002; rho = 0.63, p = 0.007; rho = 0.55, p = 0.022). Discussion: Our data corroborate the prognostic clinical value of unaffected hemisphere delta power via EEG recordings focusing on the unaffected hemisphere as an additional target for neurorehabilitation procedures. P35-5 Poststroke aphasia: evaluation of cerebral hemodynamic changes with transcranial color Doppler sonography A. Arsovska1 , A. Popovski1 , Z. Arsovski2 1 University Clinic of Neurology, Skopje, Macedonia, 2 Private Neuropsychiatry Practice ‘A. Popovski’, Skopje, Macedonia, 3 University Clinic of Pulmonology and Allergy, Skopje, Macedonia Background: Transcranial color Doppler sonography (TCD) is a noninvasive method that allows detection of the hemodynamic changes in the basal cerebral arteries related to functional neuronal changes. Aim: To evaluate the cerebral hemodynamic changes and hemispheric activation during linguistic tasks and mental activity with TCD in patients with aphasia after ischemic stroke. Material and Method: We measured hemodynamic parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), mean flow velocity (MFV)) in the middle cerebral arteries (MCAs) during language naming and object recognition tasks in 30 patients and 10 healthy control subjects. The first TCD examination was made 7 14 days after the stroke onset. Two months afterwards a control TCD was performed.
Posters Results: PSV, EDV and MFV in the left MCA were much lower in aphasia patients compared to the healthy subjects (p < 0.05) during the first TCD examination. Patients with aphasia had higher blood flow shift towards the left side during linguistic tasks (p < 0.05). On the control examination, 14 (46.6%) patients who had improved linguistic skills had higher blood flow velocities in the left side (p < 0.05). These subgroup of patients had also higher blood velocity in the right MCA during the first and control TCD examination compared to the rest of the patients with aphasia and poor linguistic abilities (p < 0.05). Conclusions: TCD can non-invasively evaluate hemodynamic changes in patients with aphasia and serve as a tool to analyze the correlation between blood flow velocity and prognosis of aphasia. P35-6 Quantitative assessment of cerebral hemodynamics in a adult moyamoya disease: evaluation with acetazolamide challenged perfusion CT and SPECT imaging K.D. Jo1 , J.H. Lee2 , S.H. You3 Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 2 Department of Diagnostic Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 3 Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea 1
Objectives: Quantitative comparison of single photon emission computerized tomography (SPECT) with perfusion CT (PCT) imaging has been rarely reported in patients with moyamoya disease. We describe quantitative cerebral hemodynamics measured by acetazolamide challenged dynamic PCT and SPECT imaging in a case of moyamoya disease. Case: A 43-year-old woman presented with frequent attacks of transient right hemiparesis. Cerebral angiography showed total occlusion of the bilateral supraclinoid internal carotid arteries (ICA) with fine basal moyamoya vessels. Brain PCT showed significant decrease in regional CBF [rCBF, anterior cerebral artery (ACA, 64.8), middle cerebral artery (MCA, 77.7), and posterior cerebral artery (PCA, 115.78)] and delay of mean transient time [MTT, ACA (5.06), MCA (4.38), and PCA (1.66)] in the bilateral ICA territories. Brain CTP after infusion of acetazolamide showed more prolonged MTT in the bilateral ICA territories compared to the bilateral PCA territories and rCBF values increased in the bilateral PCA territories but decreased in the bilateral ICA territories. The Cerebral vascular reserve (CVR) capacity decreased in the bilateral ACA ( 0.34%) and MCA ( 0.54%) territories but increased in the bilateral PCA (17.9%) territories. These findings are interpreted as evidence of severe hemodynamic impairment in the bilateral ICA territories. QuantitativeSPECT image showed mild decreased CBF in the bilateral PCA (74.3) territories compared to the bilateral ICA [ACA (88.2) and MCA (81.8)] territories. Increased CVR capacity was observed in the bilateral ACA (83.9%) and MCA (119.7%) territories than in the bilateral PCA (66.7%) territories after infusion of acetazolamide. Conclusion: Cerebral PCT confirmed significant decrease in rCBF and delay of MTT in the bilateral ICA territories. The CVR capacity was impaired with PCT but increased with SPECT imaging studies in the bilateral ICA territories. This case suggests that further comparison studies between PCT and SPECT are needed for accurately measure CBF in patients with moyamoya disease. P35-7 Cerebral hemodynamics in patients with moyamoya syndrome associated with atherosclerotic occlusion of the middle cerebral arteries K.D. Jo1 , J.H. Lee2 , S.H. You3 1 Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 2 Department of Diagnostic Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea, 3 Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea Objectives: Patients with moyamoya disease usually present with cerebral ischemic symptoms, which are most closely related to disturbed cerebral hemodynamics, and patients with moyamoya syndrome associated with atherosclerotic occlusion also sometimes display angiographic features similar to those of moyamoya disease. The hemodynamic backgrounds of the moyamoya syndrome associated with atherosclerosis have not yet been investigated. We aimed to determine the cerebral