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

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.

[1]  N. Campeau,et al.  Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging. , 2004, AJNR. American journal of neuroradiology.

[2]  C. Lampl,et al.  Central Pontine Myelinolysis , 2002, European Neurology.

[3]  T. Yen,et al.  Clinical acceptance of a molecular imaging agent: a long march with [99mTc]TRODAT. , 2007, Nuclear medicine and biology.

[4]  T. D. Paulis,et al.  The Discovery of Epidepride and Its Analogs as High-Affinity Radioligands for Imaging Extrastriatal Dopamine D2 Receptors in Human Brain , 2003 .

[5]  Ren-Shyan Liu,et al.  Crossover Study of 99mTc-TRODAT-1 SPECT and 18F-FDOPA PET in Parkinson’s Disease Patients , 2003 .

[6]  D. Costa,et al.  Molecular imaging (SPECT and PET) in the evaluation of patients with movement disorders. , 2006, Nuclear medicine review. Central & Eastern Europe.

[7]  S. Tufik,et al.  Neuroimagem do transportador de dopamina na doença de Parkinson: primeiro estudo com [99mTc]-TRODAT-1 e SPECT no Brasil , 2006 .

[8]  M. Sadeh,et al.  Extrapyramidal syndrome responsive to dopaminergic treatment following recovery from central pontine myelinolysis. , 1993, European neurology.

[9]  Kwang-Soo Lee,et al.  Decreased striatal dopamine transporter binding in a patient with extrapontine myelinolysis , 2003, Movement disorders : official journal of the Movement Disorder Society.

[10]  E. Amaro,et al.  Higher nigrostriatal dopamine neuron loss in early than late onset Parkinson's disease?—A [99mTc]‐TRODAT‐1 SPECT study , 2007, Movement disorders : official journal of the Movement Disorder Society.

[11]  T. Matsuishi,et al.  Extrapontine myelinolysis with parkinsonism after rapid correction of hyponatremia: high cerebrospinal fluid level of homovanillic acid and successful dopaminergic treatment , 1999, Journal of Neural Transmission.

[12]  C. Filley,et al.  Central and Extrapontine Myelinolysis: Then…and Now , 2006, Journal of neuropathology and experimental neurology.

[13]  R. Martin.  Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[14]  A. Rojiani,et al.  Current perspectives in the management of hyponatremia: prevention of CPM , 2007, Expert review of neurotherapeutics.

[15]  K. Hagiwara,et al.  Extensive central and extrapontine myelinolysis in a case of chronic alcoholism without hyponatremia: a case report with analysis of serial MR findings. , 2008, Internal medicine.