Images of Strokes

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Strokes are one of the leading causes of death in the U.S. They are caused by either a blood clot that chokes off blood supply to an area of the brain or by a blood vessel breaking. Cigarette smoking is one of the most significant risk factors for strokes. On SPECT, strokes are demonstrated by areas of significant decreased or absent activity. SPECT is often helpful in the evaluation and management of cerebral vascular disease. After an acute stroke’ early SPECT depicts the area of ischemia with greater accuracy than either computed tomography or magnetic resonance imaging. When the perfusion defect is large’ the likelihood of hemorrhagic complications or herniation increases. Reperfusion of an arterial territory after thrombolysis can be documented more conveniently with SPECT than with angiography. SPECT before and after the injection of acetazolamide has been used to assess the vascular reserve in patients with severe stenosis of the proximal vessels of the cerebrovascular tree. Here are several examples.

Left Frontal Stroke

Ellen, 63, was suddenly paralyzed on the right side of her body. Unable to even speak, she was in a panic and her family was extremely concerned. As drastic as these symptoms were, two hours after the event, her CAT scan was still normal. Suspecting a stroke, the emergency room physician ordered a brain SPECT study that showed a hole of activity in her left frontal lobe caused by a clot that had choked off the blood supply to this part of the brain. From this information, it was clear that a stroke had occurred and her doctors were able to take measures to limit the extent of the damage. Ellen was a smoker.

Right Side Strokes

Bill, 48 year old male with left frontal lobe stroke, affecting speech, mood and temperament. Although Bill was not a cigarette smoker, he had over 10 years of moderate marijuana smoking.

Nancy was a 59-year-old woman suffering from severe depression that had been nonresponsive to treatment. Upon admission to a psychiatric hospital a SPECT study was done to evaluate her condition. Since she had not experienced any symptoms that would point to this, I was surprised to see that she had had two large strokes. Nearly immediately her non-responsive depression had made more sense to me. Sixty percent of the people who have frontal lobe strokes experience severe depression within a year. As a result of the SPECT study, I sought immediate consultation with a neurologist who evaluated her for the possible causes of the stroke, such as plaques in the arteries of the neck or abnormal heart rhythms. He felt the stroke had come from a blood clot and placed her on blood thinning medication to prevent further strokes. Nancy was a smoker.

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