[A case of frontal lobe syndrome followed by serial 123I-IMP SPECT]

Single photon emission computed tomography (SPECT) studies with N-isopropyl-p-[123I]iodoamphetamine (IMP) were performed in a 58-year-old man with frontal lobe syndrome. He had abulia and personality changes suggesting frontal lobe impairment. Six follow-up SPECT studies were conducted during 18 months from the onset. On the first scan, no abnormal pattern of regional cerebral blood flow (rCBF) was found. On the second scan, a mild reduction of rCBF was observed in bilateral frontal lobes. Through the third to sixth scans, a progressed reduction of rCBF in bilateral frontal lobes was confirmed by a semi-quantitative regions-of-interest analysis. Contrarily, abulia was improved, and personality change was not progressed during that period. Magnetic resonance imaging on admission revealed only a small subdural hematoma and high intensity areas in the right frontal lobe, which were resolved at the time of the sixth SPECT scan. It is suggested that rCBF studies by SPECT is not necessary concordant with psychiatric symptoms, and has possible limitations in pathophysiological evaluation for psychiatric disorders.