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Reversible Increased Technetium-99m-HMPAO Cerebral Cortical Activity: A Scintigraphic Reflection of Luxuriant Hyperperfusion

Department of Radiology, Division of Nuclear Medicine, Division of Interventional Radiology and Division of Neuroradiology, State University of New York, Health Science Center at Brooklyn, New York

Correspondence: For reprints contact: Arnold M. Strashun, MD, Division of Nuclear Medicine, Box 1210, SUNY Health Science Center at Brooklyn, 450 Clarkson Ave., Brooklyn, NY 11203.

ABSTRACT

A hemiparetic and aphasic patient, 3 days after acute traumatic transection of the left internal carotid artery requiring life-saving total embolic occlusion, revealed ipsilateral increased peripheral hemispheric ^99mTc-HMPAO activity. Ten days postocclusion, HMPAO peripheral cortical flow normalized as hemiparesis and aphasia significantly cleared. The initial lateralized HMPAO hyperactivity pattern may reflect reactive hyperemia, a sign previously identified by contrast angiography and often associated with a better prognosis in evolving CVA. Evanescent peripheral cerebral hyperemia may represent beneficial cortical collateralization of the periinfarct area of a deeper lacunar (white matter) CVA.