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D. Brain Death:
1. Used
A. Tc99m DTPA Or
B. HMPAO
2. Dynamic Imaging Was Done For Brain Death
A. Assess Displacement Of Vascular Structures
B. Alterations In Disturbances Of Blood Flow: Obstruction
C. PIV Time: Immediate
1. Why? You Are Giving An IV Injection.
Imaging No Longer Performed Today:
Summary:
3. Fusion Pathology:
A. Shows Structural & Functional Pathology
A. DTPA:
1. Cannot Cross The BBB.
2. Does Not Localize In Normal Brain Areas.
3. Brain In Old Imaging Was Viewed As A Cold-Cool
Spot.
A. CT & MRI:
1. Have Excellent Resolution
2. Most Sensitive For Structural Pathology.
F. HMPAO=Hexamethylpropyleneamineoxide
18F-FDG: 18-Fluorodeoxyglucose:
A. Most Important Part Of 18FDG=Glucose.
B. Why? Glucose Analog
C. Localization In Brain Tissue :
1. Not Completely Understood But It Involves It
Crossing The BBB According To The Degree Of
Regional Cerebral Blood Flow (rCBF), Which Is
Directly Related To Neuronal Activity & Enters A Neuron But
Does Not Get Metabolized Like Glucose.& Remains In The
Neuron. It ConcentratesFrom Hot To Warm To Cool Due To The
Degree Of rCBF And Brain Metabolism/ NeuronActivity.
8. How Do Functional Pathologies Visualize When Performing
PET Or SPECT Functional Brain Imaging ?
As A Hot Or Warm Or Cold Spot ? Why Do They Visualize This Way?
A. Neurologic:
1. Epilepsy
2. Parkinsons Disease
B. Psychiatric Disorders
1. Alzheimer’s Dementia
2. Other Forms of Dementia
C. Schizophrenia
10. Explain The Specific Steps Of How F-18 FDG Localizes In The
Brain.
5. 111 In DTPA:
A. Physiological Governed By CSF Flow
B. T1/2= 2.8 Days
C. Energies= 173 Kev, 247 Kev
D. Low Patient Radiation Dose
E. Low Chemical Toxicity
F. Very High Purity
G. Administration:
1. Intrathecal : L3-L4
2. 500 uCi
3. Samples: Routine Tests &Chemical Tests Of CSF
4. Keep Patient Horizontal For 2 Hours After Injection
A. Avoid Headaches
B. Avoid Changes in CSF Pressure
6. 99Tc DTPA:
A. The Common Dose Of Injection
For A Radionuclide Angiogram: 10 mCi
B. Planar Images Of The Brain
Are Obtained 1 Hour After Injection
6. 123 HIPDM
A. Earlier Peak Activity Compared To IMP
B. Peaks At 10-15 Minutes
C. 90% Extraction Rate
D. More Stable
E. Slower Redistribution
7 Cyclic Amines:
A. 99m Tc Proplylene Amine Oxime
1. High Extraction Efficiency
2. Side Effects: Short Residence Time In
The Brain
8. Tl 201 DDC:
A. Fast Uptake
B. No Redistribution Over Many Hours
C. Disadvantage: T1/2=78 Hours
1. Give Tracer In Acute Period
D. Image Quality Not As Good As I123 Or TC99m
9. 99m Tc Pertechnetate:
A. A Patient Is Given An Injection Of Potassium
Perchlorate Before 20mCi Of 99mTcPertechnetate
The Choroid Plexus May Be Seen 1 Hour After Injection
For Static Brain Imaging.
B. If 99mTc Pertechenetate Is To Be Used In Brain Flow
Scintigraphy, The Patient Should Be Given Potassium
Perchlorate To Block the Choroid Plexus.
C. Choroid Plexus Papilloma Is A Neoplasm That Accumulates
Excessive Amounts Of Pertechenetate.
Ceretec 2.5/1
IMP 4/1
Bicisate >5/1
3. Classification Of Neurons:
A. Sensory Neurons:
1. Conduct Impulses To The Spinal Cord
Brain
B. Motor Neurons:
1. Send Impulses Away From The Spinal Cord & Brain
To the Muscles And Glands
C. Interneurons
1. Conduct Impulses From Sensory Neurons
To Motor Neurons
4. Other Cells Of The Neuronal System
A. Supporting Cells:
1. Bring The Cells Of The Neuron Tissue
Together Strucutrally & Functionally
B. Glial Cells: Neuroglia
1. Types Of Glial Cells In The CNS:
A. Astrocytes
1. Star Shaped Cells That Anchor Small Blood
Vessels To Neurons
B. Microglia:
1. Small Cells That Move Into Inflammed Brain
Tissue & Engulf By Phagocytosis The Damaged
Brain Tissue
C. Oligodendrocytes:
1. Form The Covering Myelin Sheath Of Axons
Of The Nerves
B. Schwann Cells
1. Form The Myelin Sheath On Axons In The Peripeheral
Nervous System
5. Nerve Impulses:
A. Definition:
A. Self-Propagating Wave Of Electrical Disturbance
That Travels Along The Surface Of The Neuronal
Membrane.
B. Mechanism:
A. The Stimulus Triggers The Opening Of Sodium
Channels In The Plasma Membrane Of TheNeuron
B. Sodium Enters The Neuron Leaving An Excess
Of Negative Ions Outside the Membrane Marking The
Beginning Of The Nerve Impulse. During This Period
There Is A Rise in the Action Potential
C. Calcium Maintains The Plateau Of the Action Potential.
D. Potassium Restores The Action Potential With A Drop
In The Action Potential.
E. The Relative RefractoryPeriod
1. The Period During Which Stimulation Of The Nerve
Membrane Can Activate Another Nerve Impulse
F. The Absolute Refractory Period:
1. The Period During Which Time No Impulse Can
Be Further Activated Or Propagated.
6. The Synapse:
1.Definition:
A. The Synapse Is The Site Where Chemicals (Neurotransmitters)
Are Released From Axon Terminals Of A Pre-Synaptic Neuron
Into The Neuronal Cleft.
B. Neurotransmitters Bind To Specific Receptors On The Membrane
Of The Post Synaptic Neuron & Open Ion Channels & Thereby
Stimulate Conduction By The Membrane.
C. Neurotransmitters Include
1. Acetylcholine
2. Catecholamines: Norepinephrine, Dopamine, Epinephrine:
3. Serotonin
8. The Nerve
A. The Nerve:
1. A Bundle Of Peripehral Axons
B. A Tract:
1. Is A Bundle Of Central Axons
C. The White Matter:
1. Tissue Composed Of Myelinated Axons
9. The Major Nerve Tracts:
A. The Corticospinal Tract:
1. Takes Axons & Carries Impulses From A Muscle To The Spinal
Cord White Matter To The Cerbral Cortex For Motor Function
(For Muscle Motor Movement)
B. The Spinothalamic Tract:
1. Uses Axons From The Periphery & Carries Pain & Temperature
Sensation To The Spinal Cord & Then The VPL Nucleus Of The
Thalamus & Then To The Post-Central Gyrus Of The Cerebral
Cortex
C. Dorsal Columns
D. Rubrospinal Ract
E. Tectospinal Tract
F. Spinocerebellar Tract
G. Etc.
1. Endoneurium:
A. Surrond Individual Fibers In A Nerve
2. Perineurium:
A. Surounds A Group (Fascicle) Of Nerve Fibers
3. Epineurium:
A. Surrounds The Entire Nerve
A. Longitudinal Fissure:
1. Divides The Cerebrum Into 2 Hemispheres
2. Separation Is Anterior/Posterior
3. Fissure Also Contains The Falx Cerebri.
Which Is An Extension Of The Dura Mater
B. Transverse Fissure:
1. Separates The Cerebrum From The Cerebellum
A. Cerebral Cortex
1. Largest & Most Prominent Part Of The Brain
2. Has Two Hemispheres
3. The Layers:
A. Molecular Or Plexiform Layer
B. The External Granular Layer
C. The External Pyramidal Layer
D. The Internal Granular Layer
E. The Internal Pyramidal Layer
F. The Multiform Or Fusiform Layer
4. The Cellular Components:
A. Pyramidal Cells
B. Stellate or Granule Cells
C. Stellate Or Star Pyramidal Cells
D. Fusiform Cells
E. Horizontal Cells Of Cajal
F. Cells Of Martinotti (Cells With Ascending Axons)
5. Functions:
A. Governs All Higher Mental Processes
B. Stimulates Sensation
C. Controls Motor Activities
D. Center of Reason, Intellect, Memory, Language
Consciousness
B. Diencephalom
1. Located Between The Cerebrum
& Mesencephalon
2. Components
A. Epithalamus: Pineal Gland
B. Thalamus
C. Hypothalamus
D. Subthalamus
3. Lies Near The Third Ventricle
4. Hypothalamus:
A. Connects To The Pituitary Gland
B. Sends Releasing Factors & Hormones
To The Pituitary Gland
C. Major Control Center For:
1. The Autonomic Nervous System Viz.
A. Parasympathetic System
1. Relaxation
B. The Sympathetic System:
1. Fight Or Flight Response
D. Contains Centers For:
1. Appetite
2. Wakefulness
3. Pleasure
5. Thalamus:
A. Anatomy:
1. Dumbell Shaped Masses Of Gray Matter Just
Below The Cerebral Cortex
B. Functions:
1. Relays Sensory Impulses From The Spinal Cord
& Brainstem To The Cerebral Cortex
2. Produces Pleasant & Unpleasant Emotions
6. Epithalamus: Pineal Gland
A. Functions:
1. In Control Of Day /Night Wake Cycles
2. Secretes The Hormone Melatonin For Control
Of Day/Night Wake Cycle
C. Limbic System:
A. Components:
Amygdala
Hippocampus
Fornix
Cingulate Gyrus
Parahippocampal Gyrus
B. Function:
1. Emotional Center Of Body
D. Deep Nuclei:
1. The Caudate Nucleus
2. Putamen
3. Globus Pallidus
1. Olfactory Smell
2. Optic Vision
8. Vestibulocochlear Hearing
Sense Of Balance
Functions:
A. Sensory & Motor
B. Sensations Described In Dermatomes
2. Structure:
A. Pre-Ganglionic Autonomic Neurons Conduct From
The Spinal Cord Or Brainstem To The Autonomic Ganglion
B. Post-Ganglionic Neurons Conduct From The Autonomic Ganglia To:
1. Cardiac Muscle
2. Smooth Muscle
3. Epithelial Glandular Tissue
C. Autonomic Or Visceral Effectors:
1. The Tissues To Which The Autonomic Neurons
Conduct Impulses:
A. Cardiac Muscle, Smooth Muscle &
B. Epithelial Glandular Tissue
4. Conduction Pathways:
A. Sensory Pathways
1. Consist of Two Neuron Relays:
A. Pre-Ganglionic Neurons
1. From The CNS To Autonomic Ganglia
Synapses With Post Ganglionic Neurons
B. The Post Ganglionic Neurons:
1. From The Ganglia To The Visceral Effectors
A. Cardiac Muscle
B. Smooth Muscle
C. Epithelial Glandular Tissue
B. Motor Pathways:
1. Motor Neurons Conduct From The CNS
To Somatic Effectors Viz:
1. With Intervening Synapses
1. Structure:
A. Pre-Ganglionic Neurons
1. Have Their Cell Bodies & Dendrites In The Gray
Matter Of The Brainstem &Sacrum Of The Spinal Cord
B. Pre-Ganglionic Neurons Terminate In The Parasympathetic
Ganglia Located In:
1. The Head &
2. Thoracic& Abdominal Cavities
Close To The Visceral Effectors
1. Cardiac Muscle
2. Smooth Muscle
3. Glandular Epithelial Tissue: Example: The Celiac Plexus
C. Each Parasympathetic Neuron Synapses With:
1. Post-Ganglionic Neurons To Only One Effector
D. Functions
1. Reduction In The Heart Rate
2. Increases Peristalsis &Aids In Digestion
3. Contraction Of The Bladder
4. Opens The Sphincters For Defecation & Voiding
5. Causes Iris To Contract
6. Stimulation Of The Ciliary Fibers For Near Vision
7. Increases Secretion of Digestive Juices Such As HCl
Of The Digestive Glands
Epilepsy:
D. Diagnostic Examinations:
1. Neurologic Examination
2. Physical Examination
3. EEG/ Scalp EEG
4. CT/ MRI
5. Wade Test: Analyzes The Side Of Brain In Memory Or Language
E. Types Of EEGS;
1. Interictal EEGs: To Discern The Side OF Brain’s Epileptic Focus
2. Prolonged Monitoring EEG: To Obtain Information About Ictus Phase
3. Brain Surgical Depth Electrodes:
A. Via Sterotactic Surgery
1. Interictal Or Ictal
F. Diagnostic Tests:
1. PET Scans: 18F-FDG (Metabolic Agents)
A. Choice For Evaluating Metabolism
2. SPECT: Ceretec(HMPAO) Or Bicisate (ECD) (Perfusion Agents)
A. Evaluation Of Perfusion Status
G.PET Scans:
1. FDG Localizes The Source Of Epileptic Focus
Not Visualized Many Times By CT Or MRI
Or Depth Placed Electrodes
L. Conclusions:
Thus : Epileptic Seizure Foci Typically Show
Increased Uptake Of the HMPAO During The
Ictal Phase And Decreased Uptake During
Interictal Phase .
L. PET Imaging:
A. With 15O-Water Or15 Carbon Dioxide Or
133 Xe Imaging With A Multiprobe Detector
Quantify Absolute Regional Cerebral Blood Flow.
B Study
A. Interictal Glucose Hypometabolism
& Hypoperfusion
C. Sensitivity Studies:
1. Ictal Studies More Sensitive Than Interictal
Studies For Temporal Lobe Seizures
A. Sensitivity:
1. Ictal : 85-95%
2. Interictal: 75%
N. Partial Focal Epilepsy:
1. May Benefit Surgical Intervention
2. Most Common Pathology At These Foci:
A. Mesial Temporal Sclerosis
3. 70% Of Patients With Partial Temporal
Lobectomy Experience Amelioration
& Eradication Of Seizures.
3. Types Of Infarcts:
A. Laminar Cortical Necrosis
B. Watershed Infarction
1. Area Between Main Arterial Branches
4. Flip-Flop Perfusion Is First Seen On Blood
Brain Imaging In The First Few Days
.
Flip-Flop Phenomenon:
Arterial Phase : Early Phase: Decreased Activity
Venous Phase: later Phase: Increased Activity
Static Image: Increased Activity
5. Luxury Perfusion:
A. Increased Blood Flow To An Infarct
Due To Uncoupling Of Metabolism
Seen Typicaly 5 Days After An Infarct
6. Diagnostic Procedures In CVA
A. Flow Study
1. Anterior or Posterior Views
2. Anterior View Best For Head & Neck Region
B. Immediate Post Injection BP Study:
1. Good For Arterio-Venous Malformation
C. Delayed Views:
1. Wait At Least 30 Minutes For Up To 2-3 Hours
2. Take All Four Views: Anterior, Posterior, R Lateral,
L Lateral Views & SPECT
3. Look At The Major Territory of Blood Supply
Of Brain
4. Also Take A Dome Or Vertex View
7. Diagnosis Via Nuclear Scans:
A. Acute Phase Of CVA
1. First Hours To 2-3 Days After Stroke
2. Requires A Break In The BBB
3. A Reduction In The Blood Flow To Affected Areas
4. A Cold Spot Or Cold Area: Most Sensitive Sign
B. Subacute Phase Of CVA:
1. 1-3 Weeks After Onset
2. Brain Spect Perfusion Complicated By
Increased Or “ Luxury” Perfusion Viz
The Blood Supply Is Greater Than Metabolically
Required Because The Cells Are already Dead Or
Dying
(Luxury Perfusion: A Phenomenon Of High Blood
Flow In Areas Of The Brain Involved In Non-Acute Infarction)
C. Chronic Phase Of CVA:
1. One Month After Symptom Onset
2. Luxury Perfusion Has Generally Subsided
3. Perfusion Deficits Seen On SPECT Imaging Stabilize
4. SPECT Is Limited Us In The Chronic Phase OF Stroke
3. Intense Rim
4. Good Prognostic Sign
Extradural Hematoma:
1. Definition:
A. Rupture Of The Middle Meningeal Veins
2. Scans:
A. Flow Pattern;
1. Unilateral Flattening of the Flow Pattern
On One Side
2. Contracoup Lesions From Trauma
Subdural Hematoma
1. Shows Bilaterally Reduced Flow On Dynamic Images
With Increased Uptake On Delayed Images
2. Glucoheptonate Which Usually Does Not Cross
the BBB; Crosses The BBB & Fills In A Subdural Hematoma.
3. Shows A Peripheral Crescent Shaped Area Of
Increased Tc-DTPA Uptake Best
Venous Sinus Thrombosis:
1. Often Occurs After:
A. Otitis Media
B. Mastoiditis
C. Sinusiitis
D. Trauma
2. Presents As A Large Cold Area.
Subarachnoid Hemorrhage:
1. Neurologic Deficits Within Several Weeks Of SAH
Usually The Result Of:
A. Vasospasm Induced Cerebral Ischemia
2. SPECT Imaging:
A. Defines Ischemic Areas
B. Allows For Proper Treatment Of
1. Vasospasm
2. Accompanying Ischemia
Arteriovenous Malformation:
A. Network Of Distended Dilated Vessels
B. Most Common Sites:
1. Circle OF Willis
2. The Convexity
C. Asymptomatic Or Symptomatic
D. Early Flow Images:
1. Cold Area Due To Tortuosity
2. As Time Goes On: Activity Develops There
3. Intense Activity In A Small Space Is Noted
E. Using 99m Tc-RBCs:
1. Intense Uptake On Delayed Images
E. Definitive Dx: CT/MRI
Brain Tumors:
1. 201 Tl: SPECT Brain Perfusion Imaging:
A. Localized Defects That Correspond
To The Mass Lesions
2. Used In Conjunction With Thallium 201
May Distinquish Radiation Necrosis
From Brain Tumors
A. In Malignant Gliomas Treated With
Radiotherapy.
B. May Also Be Used To Localize Recurrences
For Biopsy.
3. Tc99m HMPAO SPECT:
A. Images Show A Focal Defect
In The Region Containing Necrotic
Tissue, Recurrent Tumor Or Both
B. Grades of Activity:
1. Low Grade: Less Than Scalp Activity
2. Moderate Grade: Equal Or Up To
Twice Scalp Activity
3. High Grade: Greater Than Scalp Activity
C. Increased Thallium Activity In The Region
Of HMPAO Defect:
1. Indicative of Tumor Recurrence
D. Low Degree Of Increased Thallium Activity
1. Consistent With Radiation Necrosis
4. 18 F-FDG PET Scans & Brain Tumors:
A. Permits Differentiation Of Recurrent
Hypermetabolic Brain Neoplasia From
Hypometabolic Radiation Necrosis
B. In Patients With Astrocytomas FDG-PET
Studies Have Shown A Linear Correlation
Between Glucose Metabolic Rate & Histologic
Grade.
C. Glucocorticoids May Affect Testing:
Why? Steroid Affect Glucose Metabolism
Vs
D. Sensitivity Studies
1. Parkinson’s Dementia: 90%
2. Alzheimer Dementia 70%
E. PET Scanning Used For Alzheimer’s Disease
In Conjunction With:
1. MRI Hemodynamic Imaging
2. MRI Spectroscopy
3. Senstive Volumetric Techniques
B. PET-F18-FDG:
1. Multiple Scatterd Foci Of Hypoperfusion & Hypometabolism
Scattered Throughout Cortex , Subcortical And
Cerebellar Regions
3. Pick’s Dementia:
A. Bilateral Hypoperfusion In Frontal & Frontotemporal
Regions Favoring Pre-Frontal Regions
7. Huntington’s Chorea:
A. Chromosome 4 Defect
B. Autosomal Dominant Disorder
C. Decreased Caudate & Putamen Lobe Perfusion
8. Parkinson’s Disease:
A. SPECT & PET Scan Show Increased
Perfusion To The Contralateral Basal Ganglia.
B. Scans Also Show Decreased Basal Ganglia Perfusion
Ipsilateral To The Affected Limb.
9. Wilson’s Disease:
A. Severe Depression Of Lenticular Nuclei
Glucose Metabolism
Signs Of Hydrocephalus:
1. Ventricular Distension
2. Thinning Of The Cerebral Hemispheres
3. Atrophy
4. Mental Defects
5. Convulsions
6. Sensory Problems Example: Smell Defects
7. Difficulty In Recognition Of People
8. Visual Disturbances
9. Nausea/ Vomiting
10. Headache
11. Problems in Balance
12. Changes in Mood
Non-Obstructive Hydrocephalus
(Normal Pressure Hydrocephalus)
1. Definition:
Disturbance Of Absorption Or Formation
Of CSF Or The Circulatrion Of CSF
In The Subarachnoid Space In The Granulations
Of Pachioni
2. Some Causes:
A. Meningococcal Meninigitis
B. Thrombosis Of The Intracranial Venous Sinuses
3. Clinical Triad:
A. Ataxia
B. Urinary Incontinence
C. Dementia
Non-Communicating Hydrocephalus:
(Obstruction In The Ventricles)
1. By Injecting The Radionuclide Directly
Into The Lateral Ventricles, Communication
Between The Ventricles & The Subarachnoid Space
Can Be Discerned.
2. It May Be Of Value In The Investigation Of
Enlarged Ventricles Noted On CT When
Non-Communicating Hydrocephalus Is Suspected
Dr. Antar MD/ PhD :
Classification of Hydrocephalus:
2. Non-Obstructive Form
B. Localized Porencephaly
IIIB
Transient Ventricular Activity Communicating Hydrocephalus
Clearance Without Usual Migration With Alternative Pathway of
Resorption (Transependymal)
IV
Persistent Ventricular Activity Communicating Hydrocephalus
Inadequate Clearance
CSF Leaks:
4. Radionuclide Evaluation:
A. Image The Site of The Leak
B. Differential Activity In Pledgets Placed
Deep Into Each Nostril As Appropriate
C. Image Within 1-3 Hours
D. Half Hour Intervals After LP May Better
Allow Determination of Optimal Time To Detect
A Leak
E. Pledgets Placed Before LP Injection Of RP
F. Remove Pledgeets 4-24 Hours After Placement
& Counted In A Well Counter.
G. Concurrent Blood Serum Smaples Should Be Counted.
H. Sample Counts Are Counted In
1. Counts/ Gram
A. To Normalize For Differences In Pledget Sizes
&
C. The Amount Of Absorbed Fluid
I. Pleget/ Serum Ratios > 1.5 Indicate CSF Leaks
Dr. Antar MD/ PhD :
Acquisition:
1. Acquire 5 Minute Frame Images For 1 Hour In
The Selected View
2. Remove The Pledgets & Draw A 5 Ml Blood Sample.
3. Count The Pledgets & Count A 0.5 Ml Aliquot Of
Plasma.
4. Repeat Views May Be Indicated At 6 Hours & 24 Hours
Dr Antar MD/PhD:
5. Rx:
1. Shunts Which Divert Flow Of CSF Are
Often Used For:
A. Obstructive Communicating Hydrocephalus
B. CSF Leaks
Subdural Hematoma
< 10 Days 50%
Chronic 50%
Encephalitis 90%
AVM 95%
Substance Abuse:
1. Both Acute & Chronic Cocaine Abuse
Result In Alteration In Cerebral Blood Flow.
1. Panic Disorder:
A. PET & SPECT Imaging :
1. Dysfunction In
A. The Temporal Cortex
B. Orbitofrotnal Cortex
C. Thalamus
D. Amgydala:
1. Role In Mediating Fear & Anxiety
Behaviors
B. Rx:
1. Acute Rx:
A. Benzodiazepines:
1. Low Dose Alprazolam
B. Selective Serotonin Reuptake Inhibitors : SSRIs
1. Paroxitene
2. Sertraline
3. Citalopram
4. Escitalopram
5. Fluoxetine
2. Chronic Rx:
A. SSRIs
B. Imipramine
C. Venlafaxine
D. Etc/
2. Anxiety Disorders:
A. H2O PET Imaging:
1. Increased rCBF In The Right Parahippocampal Gyrus
In Lactate Vulnerable Patients In A Resting Non-Panic State
2. Decrease In Glucose Metabolism In The Right Occipital &
Frontal Cortex After Benzodiazepine Administration.
B. Rx:
1. Acute Rx:
1. Benzodiazepines
2. Inderal : Propanolol
2. Chronic Rx:
1. Benzodiazepines:
Example: Valium
2. Buspirone
3. Selective Anti-Depressants For
Ameliorating Insomnia
4. Combination Cognitive-Behavioral Therapy
With Pharmacotherapy
5. Bulimia Nervosa:
A. PET Imaging :
1. Global & Regional Absolute Hypometabolism
& Relative Hypometabolism In The Parietal Cortex
D. Rx:
1. Acute Rx:
A. SSRI: Selective Serotonin Reuptake Inhibitors
B. MAO Inhibitors: Monoamine Oxidase Inhibitors
C. Antidepressants: Were Associated
With More Frequent Remisssions
2. Chronic Rx:
A. Psychotherapy
6. Alcoholism;
A. FDG PET Imaging:
1. Both Cortical & Subcortical Reduction
In Metabolism; The Parietal Areas
Disproportionately Affected
B. Acute Ingestion of Alcohol:
1. Hypometabolism In Occipital, Pre-Frontal
& Cerebellar Cortices
C. Chronic Alcoholism & Cerebellar Degeneration
1. Reduced Regional Cerebral Glucose Metabolic Rates
In The Vermis
D. Acute General Treatment
1. Inpatient Treatment:
A. Lorazepam
B. Thiamine 100 Mg IV Or IM
For At Least Five Days
C. Multivitamins Oral Treament
D. Beta Adrenergic Blockers
E. Hydration IV Or Oral
F. Social Rehabilitation Group Therapy
Including Alcohol Anonymous
2. Alcohol Withdrawal:
A. Diazepam : (Valium)
B. Thiamine
C. Correct Electrolyte Imbalances
Thar May Exacerbate Seizures
3. Delerium Tremens: DTs
A. Detoxification Unit
1. Thiamine
2. Lorazepam: Initial Rx
3. Chlordiazepoxide, Lorazepam Or Diazepam:BZPs
4. Midazolam: Also Effective In Managing DTs
5. Treat Alcoholic Seizures
6. Treat Concomitant Medical, Surgical
And Psychiatric Condtions
4. Chronic Treatment:
A. Naltrexone
B. Acamprosate
C. Antabuse: Disulfiram
7. Nicotine Addiction:
A. Newest Treatments:
1. Varencicline ( Chantix)
2. Nicotine Patch
8. Schizophrenia:
Physical Presentations:
1. Hallucinations (Mostly Auditory)
2. Delusions: Mostly Bizarre
3. Disorganized Speech & Behavior
4. Catatonic Behavior
5. Negative Symptoms
6. Usually Experience Social Or Occupational Dysfunction
7. Physical Exam Often Asymptomatic, May Find
Sacccadic Eye Movements, Hypervigilance
Psychologic Testing:
1. IQ Tests: Lower Scores
2. Neurospychologic Testing
3. Personality Testing
Imaging:
A. CT Scans:
1. Enlarged Lateral & Third Ventricle, Reduced
Cortical Volumes
B. MRI:
1. Increased Cerebral Ventricles
C. Decreased rCBF In The Pre-Frontal Cortex
D. fMRI Imaging:
1. Decreased Frontal Cortical Activation
E. PET Scans: (Using D2& 5HT2A Neuroreceptors)
1. Increased Perfusion & Metabolism In The Left
Hemispheric Cerebral Cortex Relative To
The Right Cortex
2. Severity Of Symptoms Correlated With
Degree Of Hyperactivation Of The Left
Hemisphere. & Not With The Degree Of
Hypofrontality.
3. Increased Basal Ganglia Hyperactivity Relative To
The Cerebral Cortex.
4. Early et.al Found An Increase In Blood Flow
To The Left Globus Pallidus With 15O2 PET
5. After Neuroleptic Treatment : Post Therapy Scans:
A. General Increase In Glucose Metabolism In
The Temporal Lobe (DeLisi et.al.)
B. Higher Metabolism In The Temporal Cortex
6. Increased Density Of Dopamine D2 Receptor
Occupancy Occuring Especially in The Basal Ganglia
(Farde et.al).
7. The Drug’s D2 Receptor Occupancy Decreased
On Withdrawal Of Treatment.
8. Sedvall et al Also Found D1 Receptor Blockade &
Was Measured With (11C) SCH23390. This Is
A Particularly True For Clozapine.
9. PET Studies & SPECT Studies Have Shown
Decreased rCBF In The Frontal Lobes In Schizophrenia
E. Rx:
1. Acute Rx:
A. Second Generation Anti-Psychotics:
1. Risperidone
2. Olanzapine
3. Quetiapine
4. Ziprasidone
5. Aripiprazole
6. Clozapine: Resistant Cases
B. Traditional Neuroleptic Treatment
Such As Haloperidol, Perphenazine,
Fluphenazine, Chlorpromazine Use
Has Decreased Due To Propensity To
Parkinsonian Side Effects And
Eventual Tardive Dyskinesia
C. Cognitive- Behavioral Therapy
D. Family Therapy
E. Social Skills Training