INTERESTING IMAGES

Transient Aphasia as Late-Onset Seizure After Embolization
for Dural Arteriovenous Malformation
Chio Okuyama, MD, PhD,* Yo Ushijima, MD, PhD,* Kenzo Suzuki, MD, PhD,† Yoko Kin, MD,‡
Mitsukuni Tokuhiro, MD,† Yasuhiko Nakano, MD, PhD,† and Tsunehiko Nishimura, MD, PhD*

Abstract: Tc-99m HMPAO single photon emission computed tomography was performed in a patient who had experienced aphasia
for 3 days. The patient had a medical history of subarachnoid
hemorrhage and intracranial hemorrhage. Both of these hemorrhages
were related to a dural arteriovenous malformation that was embolized after the onset of the cerebral vascular events. Focal hyperperfusion was seen in the left temporal lobe adjacent to a perfusion
defect corresponding to the old cerebral hemorrhage. The finding
was interpreted as the focus of the patient’s epilepsy. His aphasia
resolved after the administration of anticonvulsant medication for
several days.
Key Words: aphasia, late onset, seizure activity, Tc-99m
HMPAO, dural arteriovenous malformation.
(Clin Nucl Med 2003;28: 685– 686)

Received for publication October 28, 2002. Accepted April 21, 2003.
From the *Department of Radiology, Graduate School of Medical Science,
Kyoto Prefectural University of Medicine; the †Department of Neurosurgery, Matsushita Memorial Hospital; and the ‡Department of Radiology,
Matsushita Memorial Hospital, Japan.
Correspondence to: Chio Okuyama, MD, PhD, Department of Radiology,
Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, Kyoto, Japan
602– 8566. E-mail: chio@koto.kpu-m.ac.jp.
Copyright © 2003 by Lippincott Williams & Wilkins
0363-9762/03/2808-0685
DOI: 10.1097/01.rlu.0000079433.88218.1a

Clinical Nuclear Medicine • Volume 28, Number 8, August 2003

FIGURE 1. A 59-year-old man was admitted to the hospital
complaining of motor aphasia that had lasted for approximately 20 hours. He had a past medical history of subarachnoid hemorrhage 10 years ago and intracranial hemorrhage 8
years ago. Both of these hemorrhages were related to a dural
arteriovenous malformation. After the vascular malformation
was embolized, the patient sometimes experienced episodes
of transient aphasia or dysphasia and dysbasia. These conditions resolved spontaneously. On admission, the patient could
write his name and simple sentences and could obey simple
orders, but he could not speak. Computed tomography of the
head revealed a low-density area corresponding to the old site
of vascular disease in the left posterior temporal region spreading to the occipital region along with a postoperative metallic
artifact. These findings were similar to those seen on computed tomographic scans performed 6 and 3 years earlier.

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Clinical Nuclear Medicine • Volume 28, Number 8, August 2003

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FIGURE 2. (A) Tc-99m HMPAO single photon emission computed tomography (SPECT) had been performed 3 years previously when the patient had a gait disturbance. The SPECT brain
scan showed a perfusion defect in the posterior and lower region
of the left temporal lobe corresponding to the site of the old
hemorrhage. Hypoperfusion was also seen in the adjacent cerebral cortex and left cerebellar hemisphere. (B) A second Tc-99m
hexamethylpropyleneamine oxime SPECT scan was performed at
the time of the patient’s hospitalization for aphasia. He had
received intravenous antiembolic and anticonvulsant therapy,
and his symptom had partially resolved at the time of the study.
The SPECT scan revealed an apparent abnormal area of hyperperfusion anterior to the perfusion defect in the left temporal
lobe. SPECT cerebral perfusion is very useful for the evaluation
and localization of epileptic foci,1,2 and there are several reports
regarding the development of seizures subsequent to vascular
events, such as stroke, subarachnoid hemorrhage, and surgery
for cerebral aneurysms.3–5 The area of hyperperfusion in this
patient suggests that the transient aphasia was a representation
of a seizure. In this case, abnormal hyperperfusion was seen in the
posterior aspect of the left temporal lobe, which seems an unusual place for aphasia, but it is the area that is related to the
processing of the Japanese language.6 It is probable that the
abnormal area had been larger when the symptoms of motor
aphasia existed and one could identify the persisting abnormality
in the focus after the symptom had already improved partially.
Late-onset seizures sometimes occur after vascular events and, in
these situations, perfusion SPECT is useful for evaluating the
epileptic focus.

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