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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
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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:



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

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