Brain glucose metabolism and dopamine D2 receptor analysis in a patient with hemiparkinsonism‐hemiatrophy syndrome

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Abstract
We report findings on brain glucose metabolism and dopamine D2 receptors generated by positron emission tomography (PET) in a 67‐year‐old woman with right hemiparkinsonism‐hemiatrophy syndrome (HP‐HA). PET with [18F]‐fluorodeoxy‐glucose (FDG) showed marked glucose metabolism asymmetry. There were significant reductions in glucose uptake at the level of the basal ganglia and, to lesser extent, in the fronto‐parietal cortex contralateral to the clinically involved side. These changes were different from those found in a patient with hemi‐Parkinson's disease who was scanned under similar conditions. Because the patient with HP‐HA had only minimal response to levodopa therapy, we evaluated post‐synaptic dopaminergic structures using PET with [18F]‐fluoroethylspiperone (FESP). No striatal binding asymmetry was found in FESP/PET, which suggests a sparing of striatal dopamine D2 receptors. The changes in FDG uptake which we found were in brain areas relevant to the clinical features of HP‐HA syndrome. In addition, our study provides evidence that FDG/PET may help to differentiate HP‐HA syndrome from hemi‐Parkinson's disease. In most instances, since HP‐HA is associated with a more benign clinical course than Parkinson's disease, this distinction is of clinical important.

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