ABSTRACT
Positron Emission Tomography (PET) has an advantage in localizing epileptogenic zones for successful surgery in several epileptic syndromes. Among the most radiopharmaceutical used in PET studies in epilepsy are [18F] fluorodeoxyglucose (FDG) and [11C]flumazenil (FMZ). Unilateral temporal hypometabolism (UTH) seen in FDGPET was shown to correlate well with ictal EEG origins in 60-90 % of temporal lobe epilepsy (TLE) patients. PET aids in surgical decision-making in TLE patients with discordant data from initial presurgical evaluation, in bitemporal disease and in nonlesional TLE. However, PET adds little in lesional TLE with congruent data. The extent of glucose hypometabolic area was shown to correlate with post-operative outcomes. PET may reduce the need for invasive EEG in bitemporal epilepsy. Abnormal FMZ binding has been proposed to guide the location of subdural electrode placement in extratemporal epilepsy (ETE). FMZ-PET and FDG-PET were shown to be sensitive in visualizing areas of cortical dysgenesis. Focal FDG-PET abnormality was demonstrated in 20 % of children with West’s syndrome and has provided a revolutionary approach for surgical treatment. Resection of the focal hypometabolism has rendered good control of infantile spasms and restoration of developmental delay. PET use of alpha-[11C] methyl-L-tryptophan (AMT), a serotonin precursor, has been shown to selectively localize epileptogenic tuber in the tuberous sclerosis complex as well as in identifying epileptic residual tissue following surgical failure. PET has potential in determining eloquent brain areas and in studying mechanisms of epilepsy. In epilepsy surgery, PET can be used with worthwhile cost-benefit even in a country with limited resources.
ABSTRACT
Behcet's disease ( BD ) is a systemic inflammatory vascular disease with variable clinical manifestations and numerous clinical masquerades. The venous involvement may affect veins of different size with tendency for thrombosis. BD is the commonest cause of cerebral venous thrombosis in some Middle Eastern countries. However, in Thailand, this clinical entity has been rarely described as a cause of cerebral venous sinus thrombosis. A 38 year-old man presented with recurrent attacks of transient ischemic attack (TIA) for 9 months. Two months after the TIA, he developed right hemiparesis and persistent diffuse headache. He had a 10 year history of recurrent oral and genital ulcers. Physical examination revealed bilateral uveitis, right hemiparesis, bilateral sixth cranial nerve paresis and bilateral papilloedema. Pathergy skin test showed positive result. Neuroimaging demonstrated empty delta sign on CT-scan and thrombosis of the posterior part of superior saggital sinus, transverse sinus, straight sinus and internal jugular vein on magnetic resonance venography (MRV). Cerebrospinal fluid (CSF) analysis revealed increased intracranial pressure and aseptic CSF profiles. Prednisolone, chlorambucil and anticoagulant had been prescribed. The clinical course improved gradually.