Ictal and Interictal 99mTc-HMPAO Brain SPECT of a MELAS Case Presented With Epilepsy-like Visual Hallucination

Wei, Cheng-Yu MD*†; Hsiao, Heng-Long MD; Chen, Shang-Chi MD§; Hung, Guang-Uei MD∥¶; Kao, Chia-Hung MD

doi: 10.1097/RLU.0b013e318262ad48
Interesting Images

Abstract: A 55-year-old woman was diagnosed with the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). She was referred for 99mTc-HMPAO brain SPECT because of visual hallucinations, which were suspected to be related to epileptic seizures. Ictal SPECT images showed remarkable hyperperfusion in the left occipital cortex, which returned to near-normal status on the interictal SPECT images after treatment with anticonvulsants. It is very rare to see such an ictal SPECT image of epileptic or epilepsy-like disorders, especially in the setting of MELAS syndrome with visual hallucination.

From the *Department of Neurology, Chang Bing Show Chwan Memorial Hospital; †Department of Health Business Administration, Meiho University, Pingtung; ‡Department of Radiology, Changhua Hospital at Department of Health, Executive Yuan; Departments of §Neurosurgery and ∥Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua; and ¶Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.

Received for publication May 27, 2008; revision accepted May 30, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Guang-Uei Hung, MD, Department of Nuclear Medicine, Chang Bing Show Chwan Hospital, 6 Lukon Rd, Lukong Town, Changhua Shien, Taiwan 505, Taiwan. E-mail: 106143@gmail.com.

Article Outline
Back to Top | Article Outline


1. Goto Y. Clinical features of MELAS and mitochondrial DNA mutations. Muscle Nerve. 1995; 3: S107–S112.
2. Green C, Buchhalter JR. Ictal SPECT in a 16-day-old infant. Clin Nucl Med. 1993; 18: 768–770.
3. Blend MJ, de León OA, Jobe TH, et al.. Cerebral perfusion SPECT imaging in epileptic and nonepileptic seizures. Clin Nucl Med. 1997; 22: 363–368.
4. Lorberboym M, Lampl Y, Gilad R, et al.. Tc-99m ethylcysteinate dimer brain SPECT perfusion imaging in ictal nonepileptic visual hallucinations. Clin Nucl Med. 2002; 27: 87–91.
5. Finsterer J, Barton P. Regression of stroke-like lesions in MELAS-syndrome after seizure control. Epileptic Disord. 2010; 12: 330–334.
6. Grünwald F, Zierz S, Broich K, et al.. HMPAO-SPECT imaging resembling Alzheimer-type dementia in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). J Nucl Med. 1990; 31: 1740–1742.
7. Miyamoto A, Oki J, Takahashi S, et al.. Serial imaging in MELAS. Neuroradiology. 1997; 39: 427–430.
8. Karkare S, Merchant S, Solomon G, et al.. MELAS with A3243G mutation presenting with occipital status epilepticus. J Child Neurol. 2009; 24: 1564–1567.

MELAS syndrome; visual hallucination; SPECT; 99mTc-HMPAO

© 2012 Lippincott Williams & Wilkins, Inc.