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CHAPTER 10 - IMAGES OF PMS
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Is It Real? You Bet!
Haley
Haley is a 12-year-old girl who presented to the clinic with violent mood swings,
aggressive behavior, prolonged tantrums, depression and oppositional behavior. Her
symptoms primarily occur several days before and after the onset of her menstrual cycle.
By the first week after the start of her period she is markedly improved, more compliant,
more positive and easier to get along with. In order to help understand the underlying
physiological abnormalities in her brain a SPECT series was performed during the worst
time of her cycle (day 3 of her menstrual cycle) and during the best time of her cycle
(day 10).
Haley's study during the worse part of her cycle was very abnormal with marked
overactivity of the cingulate gyrus (associated with obsessive thinking and problems
shifting attention), significant decreased temporal lobe activity (associated with
aggressive thoughts, hypersensitivity to others, memory problems and mood instability) and
marked decreased prefrontal cortex activity (associated with problems of impulsivity,
attention span and self-supervision).
The SPECT study during the best time of her cycle markedly improved with decreased
cingulate activity and improved function in the temporal lobes and prefrontal cortex. HL
had a positive response to medication geared toward stabilizing the temporal lobes
(Neurontin), calming cingulate hyperactivity (Zoloft) and enhancing prefrontal cortex
function (Adderall). During the worst time of her cycle she also takes Risperdal to calm
the aggressive behavior.
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Day 2 of Cycle
During Worst Time
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Day 10 of Cycle
During Best Time
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During Worst Time
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During Best Time
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side active view
notice marked increased cingulate activity
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side active view
notice calming of cingulate hyperactivity
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