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99mTc-TRODAT-1 and 123I-IBZM SPECT studies in a patient with extrapontine myelinolysis with parkinsonian features

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Abstract

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. 99mTc-TRODAT-1 and 123I-iodobenzamide (123I-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. 99mTC-TRODAT-1 and 123I-IBZM SPECT images provide presynaptic and postsynaptic molecular information of the nigrostriatal dopaminergic pathway. The lesions demonstrated in the 99mTC-TRODAT-1 and 123I-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.

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Acknowledgments

We are grateful to the Departments of Nuclear Medicine and Radiology in Tri-Service General Hospital for all the imaging studies.

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Authors and Affiliations

  1. Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan, ROC

    Yi-Chung Wu

  2. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sect. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, ROC

    Yi-Chung Wu, Giia-Sheun Peng, Chun-An Cheng, Chun-Chieh Lin & Jiunn-Tay Lee

  3. Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

    Wen-Sheng Huang

  4. Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC

    Chun-Jen Hsueh

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  1. Yi-Chung Wu
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Correspondence to Jiunn-Tay Lee.

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Wu, YC., Peng, GS., Cheng, CA. et al. 99mTc-TRODAT-1 and 123I-IBZM SPECT studies in a patient with extrapontine myelinolysis with parkinsonian features. Ann Nucl Med 23, 409–412 (2009). https://doi.org/10.1007/s12149-009-0244-6

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  • DOI: https://doi.org/10.1007/s12149-009-0244-6

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