İbrahim İYİGÜN, Yılmaz Niyazi YAZMAN, Erhan VAROĞLU, Hülya SARIYILDIZ

Akut serebral iskemik stroklu hastaların spect bulguları ile BT ve nörolojik bulgularının karşılaştırılması

Bu çalışmada bir grup akut iskemik stroklu hastada BT ve SPECT bulgularının hastalık tanısındaki yeri ve önemi karşılaştırılmak istendi. Bu amaçla kliniğimize yatırılan 23-90 yaşları arasındaki 21 erkek ve 17 kadın toplam 38 hasta çalışma kapsamına alındı. Bu hastaların 32'sinin gelişmiş enfarktları, 6'sının ise geçici iskemik atağı vardı. Tüm hastalarda BT, poststrok ilk 24 saat içinde çekildi. Poststrok 3. günden sonra tekrar edildi. Hastaların Tc-99 m HMPAO SPECT'leri ise sadece poststrok ilk 24 saat içinde BT çekiminden sonra aynı gün içinde gerçekleştirildi, Poststrok ilk. 24 saat içinde çekilen BT'lerde ancak 13 hastada (%34.3) iskemik enfarkt belirlenebilirken, 72 saat sonra tekrar edilen BT'lerde 28 hastada (%82.3) iskemik enfarkt belirlenebildi ve bu hastaların yalnızca 22'sinde (%64.7) klinik bulgular ile BT bulguları birbiri ile uyumlu idi. Hastaların poststrok ilk 24 saati içinde çekilen SPECT'lerinde ise 36 vakada (%94.7) lezyon belirlendi ve bu belirlenen lezyonlarm tümünün klinik bulgular ile uyumlu olduğu ve ayrıca BT'de gözlenen lezyonlardan da vizüel olarak daha büyük olduğu gözlendi. Bizim bu çalışmamızın sonucu; sadece morfolojik görüntüleme yöntemleri ile (BT gibi) klinik bulguları açıklanamayan hastalarda SPECT'in rutine girmesinin yararlı olacağını göstermiştir.

Comparison of CT findings and neurological signs between spect findings in patients with acute cerebral ischemic stroke

in this study; the presence and importance of CT and SPECT findings is compared on the patients have acute ischemic stroke. 21 male and 17 female, totally 38 patients who are about at 23-90 ages, is performed in our clinic. 32 of them had developed infarcts and 6 of them had transient ischemic attack. CT is applied in 24 hours on ali patients and repeated after the third day. Only the poststroke of Tc-99 m HMPAO SPECT's of patients is done at the same day of CT undergoing in first 24 hours. in 13 patients (34.3 %) ischemic infarct was determined at 24 hours of CT applying. After 72 hours ischemic infarct was determined in 28 patients (82.3 %) who CT is undergone again. And 22 of them (64.2 %) had similarity betvveen clinic findings and CT findings. Lesion was determined on 36 event (94.7 %) in first 24 hours of SPECT applying and ali determined lesions were similar with clinic findings and also at lesions observed in CT were smaller than them as visual. The result of our study shows that using of SPECT is useful only at morphologic visualising method (like CT) with the patients had unknown clinic findings.

PDF

___

1. Sarıbaş 0, Baysal A, Kurtoğlu R. Beyin Damar Hastalıklarında Teşhis ve Tedavi. Ankara: Gazi Üniversitesi Yayın, 1983; 23: 23-115
2. Lee RG, Hill TC, Holman BL, et al. N-lsopropyl (1-123) P- lodoamphetamine brain scans with single-photon emission tomography. Radiology 1982;145: 795-799
3. Fayad P, Brass ML. Single photon emission computed tomography in cerebrovascular disease. Stroke 1991; 26: 7-12
4. Tuncel E. Diagnostic Radyoloji. Bursa: Taş Kitapçılık, 1988: 215-219
5. Shuaib A, Hachinski VC. Mechanism and management of stroke in the elderly. Current review. Can Med Assoc J 1991; 145:433-443
6 Özdemir G. İskemik Strok’ta Akut Tedavi İlkeleri. Eskişehir: Beyin Damar Hastalıkları Derneği Yayın No:2, 1995
7. Siesjo BK, Ekholm A, Katsura K, Theander S. Acid-base changes during complete brain ischemia. Stroke 1990;21: 194-199
8. Feldmann H, Woth E, Dressler D, Henze T, Felgenhaver K. 99 m Tc- Hexamethylpropylene amine oxime SPECT and X- ray CT in acute cerebral ischemia. J Neurol 1990; 237: 475- 479
9. Alexandrov A, Bladin CF, Norris JW. Intracranial blood flow velocities in acute ischemic stoke Stoke. 1994; 25:1378- 1383
10. Dewer D, Wallece MC, Kurumaji A, Mc Culloch J. Alterations in the N Methyl-D-Aspartate receptor complex following focal cerebral ischemia. J Cerebr Blood Flow Metab 1989; 9: 709- 712
11. Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Pathophysiology J Neurosurg 1992; 77: 169-184
12. Laloux P, Brichant C, Cauwe F, et al. Techetium- 99 m HMPAO single photon emission computed tomography: imaging in transient global amnesia. Arch Neurol 1992; 49: 543-546
13. Ackerman RH. Cerebral blood flow: stroke and SPECT. Stroke 1984;15: 1-4
14. Yamauchi H, Fukuyama H, Kimura J, lschikawa M. Crossed cerebellar hypoperfusion indicates the degree of uncoupling between blood flow and metabolism in major cerebral arterial occlusion. Stroke 1994; 25: 1945-1951
15. lnfeld B, Davis S, Hopper JL. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke 1995; 26: 90-95
16. Bowler JV, Wade JPH, Jones BE. Contribution of diaschisis to the clinical deficit in human cerebral infarction. Stroke 1995; 260: 1000-1006
17. Sakashita Y, Matsuda H, Kakuda K, Takamori M. Hypoperfusion and vasoreactivity in the thalamus and cerebellum after stroke. Stroke 1993; 24: 94-97
18. Alavi A, Dann R, Chawluk J, Alavi J, Kushner M, Reivich M. Position emission tomography imaging of regional cerebral glucose metbolism. Semin Nucl Med 1986; 16: 2-34
19. Von Heertum LR, Miller SH, Mosesson RE. SPECT brain imaging in neurologic disease. Radiol Clin North Am 1993; 31: 881-900
20. Salgado ED, Weinstein M, Furlan AJ, et al. Proton magnetic resonance imaging in ischemic cerebrovascular disease. Ann Neurol 1986;20:502-507
21. Phelps ME, Mazziotta JC, Huarg SC. Study of cerebral function with position computed tomography. J Cereb Blood Flow Metab 1982; 2:113-162 22. Limburg M, Royen EA, Hijdra A. Single-Photon emission computed tomography and early death in acute ischemic stroke. Stroke 1990; 21:1150-1155
23 Laloux P, Richelle F,Jamart J, Laterne C. Comparative correlations of HMPAO SPECT indices, neurological score, and stroke subtypes with clinical outcome in acute carotid infarcts. Stroke 1995;26:816-821
24. Hayman LA, Taber KH, Jhingran SG, Killian JM, Carroll RG. Cerebral infarction: diagnosis and assesment of prognosis by using 123 IMP-SPECT and CT. AJNR Am J Neuroradiol 1989; 10:557-562
25. Special article assesment of brain SPECT report of the therapeutics and techonology assesment subcommitee of the American Academy of Neurology. Neurology 1996; 460: 278- 285