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Eli Shahar, MD; David L. Gilday, MD; Paul A. Hwang, MD; E. K. Cohen, MD; Raymond Lambert, MD

Arch Neurol. 1990;47(5):578-584.

Abstract
• Regional cerebral blood flow (rCBF) alterations, as determined by single photon emission computed tomography (SPECT) using technetium Tc 99m hexamethyl propylenamine oxime (Tc 99m-HMPAO), were studied in 15 infants and children presenting with cerebrovascular disorders between the ages of 2 weeks and 16 years. The rCBF patterns were correlated with clinical presentation, electroencephalographic patterns, radiologic studies, including computed tomography and magnetic resonance imaging of the head, and cerebral angiography. All patients presented with motor weakness that was accompanied in some with dysphasia, defects in visual fields, obtundation, seizures, and high temperature. Perturbations of rCBF with Tc 99m-HMPAO SPECT brain scanning were detected in all patients investigated, with no adverse effects related to the radiotracer. All patients had a focal area of decreased rCBF, with adjacent hyperemia in 3 patients. In 7 patients, there was an rCBF decrease in a vascular distribution, mainly that of the middle cerebral artery, that correlated with the clinical findings and a focal electroencephalogram, as well as computed tomography and magnetic resonance imaging of the head. Impairment of rCBF was more extensive in 3 children, while early abnormal SPECT findings preceded abnormal computed tomographic findings in another 2 children. In 2 patients, Tc 99m-HMPAO SPECT was the only positive radiologic test to correlate with focal clinical and electroencephalographic abnormalities, in view of repeated normal computed tomographic scans. We conclude that Tc 99m-HMPAO SPECT brain scanning is a sensitive, complementary diagnostic measure in the early detection, localization, and estimation of rCBF alterations in pediatric cerebrovascular disease.

Author Affiliations
From the Division of Neurology, Department of Pediatrics (Drs Shahar and Hwang), and the Divisions of Nuclear Medicine (Drs Gilday and Lambert) and Neuroradiology (Dr Cohen), Department of Radiology, Hospital for Sick Children, University of Toronto (Canada). Dr Shahar is now with the Child Neurology Unit, Division of Pediatrics, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Footnotes
Accepted for publication August 16, 1989.

Presented, in part, at the Twenty-third Meeting of the Canadian Congress of Neurological Sciences, Quebec city, Canada, June 1988.

Reprint requests to Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto Faculty of Medicine, 1 Kings Circle, Toronto, Ontario, Canada M5S1A8 (Dr Hwang).

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