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Technetium-99m HM-PAO Brain SPECT in Epileptic Patients before and during Unilateral Hemispheric Anesthesia (Wada Test): Report of Three Cases

Institute for Clinical and Experimental Nuclear Medicine, Division of Clinical Electro-Physiology, Department of Neurosurgery, and Department of Epileptology, University of Bonn, FRG

Correspondence: For reprints contact: H.J. Biersack, MD, Institute for Clinical and Experimental Nuclear Medicine, University of Bonn, Sigmund-Freud-Str. 25, D-5300 Bonn-1.

ABSTRACT

The lipophilic brain SPECT agent [^99mTc]hexamethyl propylene amine oxime (HM-PAO) was used in three cases before and during unilateral anesthesia of one hemisphere for lateralization of speech dominance (Wada test). This procedure led to a decrease of regional cerebral blood flow (rCBF) in each of the hemispheres to 55 and 90%, respectively. Diminution of rCBF was significantly more pronounced in the dominant hemisphere. A second phenomenon observed during the Wada test was crossed cerebellar diaschisis. These findings support the assumption that HM-PAO allows monitoring of brain perfusion, as rapid changes of rCBF due to decreased neuronal activity cause respective alterations of cerebral and cerebellar uptake of this new brain agent.

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