Brain scans

There has been contradictory evidence of ECT damage in brain scan studies, most of which have been carried out by staunch advocates of the 

Coffey et al. (1991), using MRI, studied 35 patients before and after ECT. The follow-ups were 2 or 3 days after and 6 months after. In five subjects, they found an apparent increase in subcortical hyperintensity. Coffey, a strong ECT advocate who has performed shock on many patients, dismissed his own finding as most likely secondary to progression of ongoing cerebrovascular disease during follow up. I have seen several other patients with very similar post-ECT MRI findings. 

Pande et al. (1990) found no MRI pathology in seven ECT patients. However, the studies were performed 1 week after the last ECT so that late-maturing pathology would not have been discovered. Bergsholm et al. (1989) found no pathology on MRI in 40 patients, with the exception of a 69-year-old man, who suffered a dilatation of the left temporal horn, which the authors dismissed as unrelated to ECT. 

Devanand et al. (1994) reviewed the brain scan literature and found the evidence for brain damage unconvincing. They accepted Coffey et al. s (1991) unsubstantiated claim that the four damaged patients had progressive cerebral vascular disease, rather than ECT pathology. They dismissed studies showing damage. 

For the past 40 and more years, a modified form of ECT has been standard, involving sedation with a short-acting barbiturate, muscle paralysis with a curare derivative or similar drugs that prevent activation of the muscles of the body, and artificial respiration with oxygen. The purpose 

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A PET scan requires a substance called a tracer. A suitable tracer must accumulate in the target organ, and it must be modified to contain unstable radioactive atoms that emit positrons. Glucose is used for brain imaging, because the brain processes glucose as the fuel for mental and neural activities. A common tracer for PET brain scans is glucose modified to contain radioactive fluorine atoms. Our molecular inset shows a simplified model of this modified glucose molecule. 

Brain scans are used to study epiiepsy, brain tumors, strokes, Aizheimer s disease, and mentai iiiness. Each of these disorders generates a unique brain activity pattern that differs from the pattern seen in normai brains. Physicians interpret these patterns both for diagnosis and to indicate appropriate treatment. 

Serotonin (5-HT) abnormalities. Schizophrenic patients with abnormal brain scans have higher whole blood 5-HT concentrations, and these concentrations correlate with increased ventricular size. 

Finally, a laboratory evaluation completes the initial evaluation. This includes a battery of blood tests to rule out infection, metabolic abnormality, or hormonal disturbance. It must also include a drug screen. Unfortunately, most drug screens do not detect the designer drugs like Ecstasy that are an ever-increasing cause of acute psychosis. The initial evaluation should always include a CT or MRI brain scan, preferably the latter. 

Psychotic Disorder Due to Generai Medical Condition. Certain medical illnesses occasionally present with symptoms of paranoid delnsions or hallucinations that resemble schizophrenia (Table 4.4). When these illnesses are snccessfully treated, fnll resolntion of the psychotic symptoms invariably occnrs. All patients presenting with new-onset psychosis shonld nndergo a thorongh medical evaluation including a physical exam, family and personal medical history, and laboratory stndies inclnding electrolytes, thyroid function tests, syphilis screen, vitamin B12 and folate levels, and a CT or MRI brain scan. A lumbar puncture (spinal tap) and electroencephalogram are sometimes also warranted. 

Mandatory studies Complete blood count Blood electrolytes Liver enzymes Urinalysis Vitamin B,2 level Folate level Syphilis (RPR/VDRL) Thyroid-stimulating hormone (TSH) Brain scan (CT or MRI) Electrocardiograph (EKG)... 

Thyroid 1 uptake may be decreased. False-negative results with the nitroblue-tetrazolium test for bacterial infection. Dexamethasone, given for cerebral edema, may alter the results of a brain scan (decreased uptake of radioactive material). 

Clinically significant pituitary disease is rare, although small functionless pituitary adenomas are commonly seen as incidental findings at autopsy or on magnetic resonance brain scans. The main issues for clinical pharmacology concern replacement therapy for hypopituitarism, and treatment of hormone-producing pituitary adenomas. 

T. Irie, K. Fukushi, O. Inoue, T. Yamasaki, Y. Kasida, 18F-labelled 6-fluoro-purine derivatives as a new type brain scanning agent, J. Label. Compds Radiopharm. 19(1982) 1641-1642. 

This brain scan of a schizophrenic patient, taken whiie he was haiiucinating, shows highiy active areas in the visuai and auditory parts of the brain, suggesting the haiiucination was the resuit of abnormai activity in these areas. [D. Sllbersweig/Photo Researchers, Inc.]... 

In order to absolutely confirm the presence of AD, the brain must be biopsied immediately after death. What is found is a general deterioration of brain neurons and the presence of excessive quantities of neurofibrillary tangles (twisted neuron bundles) and amorphous amyloid protein. In 1907 it was the neurofibrillary tangles which Alois Alzheimer first associated with the condition which bears his name. Today clinical psychiatric evaluations, PET brain scans for utilization of glucose as well as NMR are used to help in the diagnosis of AD. It is extremely difficult to differentiate AD from other types of... 

Measurements of structural abnormalities using CT or MRI brain scans Measurements of functional or physiological abnormalities using PET, EEG, evoked potentials, or magnetoencephalography... 

A Technetium-99m, a short-lived radioisotope used for brain scans, is obtained by neutron bombardment of molybdenum-99 and then stored in a "molybdenum cow" in the form of Mo042. Small amounts are removed by passing a saline solution through the cylinder. 

FIGURE 5.18 MRI brain scan of a healthy human, with various positions marked. The patient is lying in a 1.5 Tesla magnet. Contrast in the image comes from variations in water properties (density, linewidth) in the various tissue regions. 

In 1997, researchers at Brookhaven National Laboratory published a report that provided further evidence to support what other scientists have discovered about addiction. Cocaine addicts were given cocaine by vein, and then brain scans were performed to measure the activity of the system that governs the reabsorption of dopamine (dopamine transporter system, or DAT). 2 The researchers discovered that their subjects reported feeling high when at least 50 percent of the DAT molecules were blocked. The more transporter sites that were blocked by cocaine, the more intense the high. 

Permanent mental problems, including poor judgment and inappropriate behavior, have been found to occur with long-term use and may be due to brain damage. In one survey, brain scans demonstrated shrinkage of the brain cortex in 50 percent of the chronic users who were studied. -... 

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