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SPECT IN CONCUSSION, VERTEBRO-BASILAR INSUFFICIENCY AND OTHER NEUROLOGICAL DISORDERS Novel applications and insights ,[object Object],[object Object],[object Object]
LEARNING OBJECTIVES ,[object Object],[object Object]
Imaging Brain function using SPECT All India Institute of Medical Sciences, New Delhi
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
SPECT in TRAUMA
[object Object],[object Object],[object Object],[object Object],[object Object],Imaging Brain function using SPECT
Medial Temporal Injury In Pediatric Postconcussion Syndrome ,[object Object],[object Object]
[object Object],[object Object],[object Object],Rempel-Clower NL, Zola SM, Squire LR, Amaral DG. Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation. J Neurosci 1996;16:5233-5255. Temporal lobe damage in minor head injury
[object Object],[object Object],[object Object],Temporal lobe damage in minor head injury
[object Object],[object Object],[object Object],[object Object],Temporal lobe damage in minor head injury
[object Object],[object Object],[object Object],[object Object],[criteria published by the members of the Mild Traumatic brain injury Interdisciplinary Special Interest Group (BISIG)] Kay T, Harrington DE, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86 Temporal lobe damage in minor head injury
[object Object],[object Object],[object Object],[object Object],POST CONCUSSION SYNDROME: (2 or more of the following) Temporal lobe damage in minor head injury DSM IV criteria   Brown SJ, Fann JR, Grant I: Postconcussion disorder: time to acknowledge a common source of neurobehavioural morbidity. J Neuropsychiatry Clin Neurosci 6:15-22, 1994
[object Object],INVESTIGATIONS ,[object Object],[object Object],Temporal lobe damage in minor head injury
[object Object],[object Object],SPECT METHODOLOGY Temporal lobe damage in minor head injury
[object Object],Temporal lobe damage in minor head injury 30 Children with minor head injury Normal CT head & Post concussion Syndrome (PCS) SPECT scan (within 72 hrs) Medial temporal hypoperfusion (n=14 )(“MTH”) No Medial temporal hypoperfusion (n=16 )(“ control” ) 3 months later Repeat SPECT & clinical evaluation (PPCS) 3 months later Repeat SPECT & clinical evaluation (PPCS)
[object Object],[object Object],[object Object],Temporal lobe damage in minor head injury
Baseline At 3 months
12/14 (86%) children developed PPCS in the MTH group, compared to 2/16 (12.5%) children in the control group P=0.0003 Temporal lobe damage in minor head injury RESULTS Persistent post concussion syndrome (PPCS)
[object Object],[object Object],[object Object],Temporal lobe damage in minor head injury
 
[object Object]
ROLE OF PIRACETAM IN POST-CONCUSSION SYNDROME  A PROSPECTIVE RANDOMIZED STUDY Deepak Agrawal, K Naveen*, CS Bal*, AK Mahapatra Departments of Neurosurgery* and Nuclear medicine*, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, INDIA
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Piracetam in minor head injury
[object Object],[object Object],[object Object],[object Object],Piracetam in minor head injury
[object Object],[object Object],Piracetam in minor head injury
[object Object],[object Object],[object Object],MINOR HEAD INJURY [criteria published by the Mild Traumatic brain injury Interdisciplinary Special Interest Group (BISIG)] Kay T, Harrington DE, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86 Piracetam in minor head injury
[object Object],[object Object],[object Object],[object Object],POST CONCUSSION SYNDROME: (2 or more of the following) DSM IV criteria based on recommendation of Brown et al. Brown SJ, Fann JR, Grant I: Postconcussion disorder: time to acknowledge a common source of neurobehavioural morbidity. J Neuropsychiatry Clin Neurosci 6:15-22, 1994 Piracetam in minor head injury
[object Object],[object Object],[object Object],Piracetam in minor head injury
[object Object],INVESTIGATION ,[object Object],[object Object],Piracetam in minor head injury
[object Object],SPECT Piracetam in minor head injury
Piracetam in minor head injury
[object Object],Regional cerebral perfusion <10% of contralateral lobe, or in case of bilateral involvement, less than 20% of cerebellum ABNORMAL SPECT SCAN Piracetam in minor head injury
Piracetam in minor head injury STUDY DESIGN 20 PATIENTS WITH POSTCONCUSSION SYNDROME & ABNORMAL SPECT PIRACETAM GROUP CONTROL GROUP 10 PATIENTS 800 mg PIRACETAM (Cerecetam) TDS x 6 WEEKS CLINICAL EVALUATION & REPEAT SPECT AT 6 WEEKS 10 PATIENTS NO PIRACETAM CLINICAL EVALUATION & REPEAT SPECT AT 6 WEEKS
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Piracetam in minor head injury
[object Object],CONCLUSIONS Piracetam in minor head injury
Imaging Brain function using SPECT
CRANIO-CERVICAL JUNCTION ANOMALIES AS A CAUSE OF VERTEBRO-BASILAR INSUFFICIENCY   Deepak Agrawal, Naveen K*, SS kale, C S Bal*, A K Mahapatra Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical Sciences, New Delhi-110029
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],SPECT In vertebrobasilar insufficiency Chronic low grade micro-trauma Repeated flex/extn of vessel Intimal damage Thrombosis Embolisation
[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],SPECT In vertebrobasilar insufficiency AAD: Atlanto-axial dislocation 19 PATIENTS WITH IRREDUCIBLE AAD Clinical assessment & Brain SPECT on admission CONTROL GROUP (7 PTS) VBI GROUP (12 PTS) Transoral Odontoidectomy + Posterior Fusion Transoral Odontoidectomy + Posterior Fusion Rpt SPECT at 4 weeks Rpt SPECT at 4 weeks
[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency SPECT
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
SPECT In vertebrobasilar insufficiency Baseline At 1 month postop
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object],[object Object],[object Object],SPECT In vertebrobasilar insufficiency
[object Object]
[object Object],[object Object],[object Object]
[object Object]

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Spect in concussion, vertebro basilar insufficiency and other neurological disorders

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  • 3. Imaging Brain function using SPECT All India Institute of Medical Sciences, New Delhi
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  • 28.
  • 29.
  • 30. Baseline At 3 months
  • 31. 12/14 (86%) children developed PPCS in the MTH group, compared to 2/16 (12.5%) children in the control group P=0.0003 Temporal lobe damage in minor head injury RESULTS Persistent post concussion syndrome (PPCS)
  • 32.
  • 33.  
  • 34.
  • 35. ROLE OF PIRACETAM IN POST-CONCUSSION SYNDROME A PROSPECTIVE RANDOMIZED STUDY Deepak Agrawal, K Naveen*, CS Bal*, AK Mahapatra Departments of Neurosurgery* and Nuclear medicine*, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, INDIA
  • 36.
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  • 44. Piracetam in minor head injury
  • 45.
  • 46. Piracetam in minor head injury STUDY DESIGN 20 PATIENTS WITH POSTCONCUSSION SYNDROME & ABNORMAL SPECT PIRACETAM GROUP CONTROL GROUP 10 PATIENTS 800 mg PIRACETAM (Cerecetam) TDS x 6 WEEKS CLINICAL EVALUATION & REPEAT SPECT AT 6 WEEKS 10 PATIENTS NO PIRACETAM CLINICAL EVALUATION & REPEAT SPECT AT 6 WEEKS
  • 47.
  • 48.
  • 49.
  • 50. Imaging Brain function using SPECT
  • 51. CRANIO-CERVICAL JUNCTION ANOMALIES AS A CAUSE OF VERTEBRO-BASILAR INSUFFICIENCY Deepak Agrawal, Naveen K*, SS kale, C S Bal*, A K Mahapatra Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical Sciences, New Delhi-110029
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  • 68. SPECT In vertebrobasilar insufficiency Baseline At 1 month postop
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Notas del editor

  1. This is the hospital I did my residency in as well the research using SPECT
  2. 2. For our Imaging need we have
  3. A number of imaging techniques are available for use in neurosciences and can be braodly divided into …
  4. In..
  5. The Biochemical interactions between brain tissue and injected substance (HMPAO,ECD, Iophane) form the underlying principle of SPECT. However to make these interactions recordable these substances have to be labeled with radioactive tracers ( 99m HMPAO, 99m ECD, 123 I-iophane)
  6. And the radio activity of the trapped sbstances forms the basis of SPECT
  7. Although SPECT can &amp; is used for imaging the whole body, Brain SPECT has two important uses… 1 To see for regional cerebral perfusion and the most commonly used rediopharamceuticals for this purpose are the Hexam methyl .. And Ethylene Cysteine Dimer 2ndly For imaging of the neurotransmitter systems using radiopharmaceutical Ioflupane
  8. It is well known tha…. In a presentation in this very auditorium a few weeks by my collegue on pediatric head injury and outcome prediction back it was c
  9. The hippocampus is a key structure in the medial temporal lobe, and is located within the hippocampal formation, that also includes the dentate gyrus, subicular complex, and entorhinal cortex. &amp; The reason we decided to target MTL in patients with concussion was …
  10. Just to get a few definations out of the way-There are a number for different criteria defining minor head injury. We decided to stick to this definition as it is very simple to apply and has been around for a relatively long time to be validated
  11. The definition of PCS is more tenacious and we used the DSM 4 criteria to define PCS. This critria include...
  12. Our research on post concussion syndrome focussed on the medial temporal lobe. This research has been published in the JNS a couple of months back
  13. We decided to use a pharmacological intervention and use SPECT to see its utility
  14. To briefly describe this drug which we used in our next study
  15. So we did not use much creativity and did the same study all over again, except that we used an intervention in the form of piracetam
  16. The way SPECT methodology differed from the previous study was in quantification of the cerebral perfusion. Compared to visual scale previously we used Circular region of interest (ROI)
  17. Radiotracer counts
  18. During my posting in neurology department, I became interested in stroke. However, as the posting was of two months duration only, I could not conduct any studies. On return to my own department, I realized that many patients with cranio-cervical junction anomalies had features of posterior circulation ischemia.
  19. We therefore decided to study CCJ anomalies as a cause of verterbro basilar insufficiency.
  20. At the outset we were concerned whether SPECT could assess the posterior circulation adequately. A review of the literature however dispelled our doubts.
  21. And the reason we rised this question was…