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We report a 47-year-old woman who developed an ischemic stroke with diplopia and dysarthria. Emergency computed tomography (CT) showed no pathological findings, and magnetic resonance (MR) showed mild ischemic-degenerative lesions. MR angiography and angiogram showed severe stenosis of both internal carotid and main intracranial arteries with plenty collateral vessels with "puff of smoke" suggesting a moyamoya disease (MMD). Brain perfusion single-photon emission CT showed global diminished perfusion in the brain lobes and a marked relative hyperperfusion in the cerebellum. However, brain 18 F-fluorodeoxyglucose-positron emission tomography showed physiological metabolism in the brain cortex with only slightly relative cerebellar hypermetabolism. MMD is a well-known arterial pathology that frequently develops with only mild symptoms until the middle age. Functional neuroimaging findings indicate a mismatch between brain glucose metabolism and brain perfusion, probably due to neuronal subclinical chronic ischemia in the brain cortex with preserved viability of neurons.

indian journal of nuclear medicine

Mismatch in Brain Perfusion and Metabolism Detected with <sup>99m</sup>Tc-Hexamethyl Propylene Amine Oxime Single Photon Emission Computed Tomography and <sup>18</sup>F-Fluorodeoxyglucose Positron Emission Tomography in Moyamoya Disease

Mismatch in Brain Perfusion and Metabolism Detected with 99mTc-Hexamethyl Propylene Amine Oxime Single Photon Emission Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography in Moyamoya Disease

Mismatch in Brain Perfusion and Metabolism Detected with ^99mTc-Hexamethyl Propylene Amine Oxime Single Photon Emission Computed Tomography and ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography in Moyamoya Disease