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Results
Auditory hallucinations
During perception of auditory hallucinations the patient presented a significant increase of function in area 39 of Brodmann in the right hemisphere, with a maximal function at 4.7 Standard Deviations (S.D.) above the normal mean uptake of HMPAO in the cerebral cortex. Fig. 5. However, in the left hemisphere there was a lesser increase at 2.8 S.D. above the normal mean. In area 40, that projects on the left hemisphere in the Wernicke area, the increased functional change was milder, namely 2 and 1.9 S.D. above normal for right and left hemispheres respectively. Fig. 6. Furthermore, in the frontal cortex there was a marked increase of function in the executive cortex, namely areas 6, 8, 9, and 10 of Brodmann. In the right hemisphere maximal values were 2.4, 2, 3.5, and 4.0 S.D. above the normal mean; while the respective values in the left hemisphere were 2, 2.3, 3.8, and 4.0. In the temporal lobes, however, there was a diminution of function with a mean uptake of HMPAO in areas 21, 22 and 38 of -1.4, -0.9, and -0.4 in the right hemisphere. Similar results were recorded for the left hemisphere. Please see Table 2
Table 2
| - |
Standard Dev. Above Normal Mean
|
| Maximun perfusion |
Controls
|
Hallucinations
|
Putamen - Left.roi
Putamen - Right.roi
Thalamus - Left.roi
Thalamus - Right.roi
Caudate Nucleus - Left.roi
Caudate Nucleus - Right.roi |
4.03 ± 0.46
3.75 ± 1.01
2.90 ± 0.26
3.28 ± 0.56
2.10 ± 0.39
2.13 ±0.87
|
5
5
3,3
4,7
3
4,2
|
Area 6 - Left.roi
Area 6 - Right.roi
Area 7 - Left.roi
Area 7 - Right.roi
Area 8 - Left.roi
Area 8 - Right.roi
Area 9 - Left.roi
Area 9 - Right.roi
Area 10 - Left.roi
Area 10 - Right.roi
Area 39 - Left.roi
Area 39 - Right.roi
Area 40 - Left.roi
Area 40 - Right.roi |
2.63 ± 1.70
3.28 ± 1.70
3.48 ± 1.41
3.83 ± 0.74
3.10 ± 1.86
3.88 ± 1.87
3.98 ± 1.86
3.73 ± 2.11
3.85 ± 1.81
3.95 ± 1.97
2.95 ± 0.60
3.95 ± 0.37
2.15 ± 0.97
3.38 ± 1.41
|
2
2,4
3
3,9
2,3
2
3,8
3,5
4
4,1
2,8
4,7
1,9
2
|
| - |
( ) Standard Dev. Below Normal Mean
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| Maximun perfusion |
Controls
|
Hallucinations
|
Area 21 - Left.roi
Area 21 - Right.roi
Area 22 - Left.roi
Area 22 - Right.roi
Area 38 - Left.roi
Area 38 - Right.roi |
(3.45) ± 1.11
(2.35) ± 0.37
(3.75) ± 1.08
(3.08) ± 1.31
(3.45) ± 0.53
(3.18) ± 1.28
|
-2,2
-2,7
-2,4
-2,5
-2,6
-1,9
|
|
0
|
0
|
0
|
 |
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Figure 5. NeuroSPECT HMPAO cortical function during Auditory Hallucinations.
3D images of the brain in 70 years old woman . Color gray depicts normal brain perfusion ( mean ± 2 SD. Colors red, pink and white denote areas increased at 2, 3 and 4 S:D. above the normal mean respectively. Colors light blue, dark blue and green denote diminution of perfusion at 2, 3 and 4 SD below the normal mean respectively. There is a strong activation of right posterior parietal, both frontal lobes, weak left posterior parietal and mild diminution of function in lateral temporal lobes, Increased visual cortex is a normal finding.
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Figure 6. During Auditory Hallucinations there is increased function in Right area 39 and 40, also in area 10 and 9 in the frontal cortex and diminution of function in area 21 of the temporal lobe.
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Normal controls
In the normal controls during auditory activation in the sound proof room a similar phenomenon was detected. In area 39 there was an increase in perfusion with a maximum of 3.9 S.D. above the normal mean in the right hemisphere and in the left area 39 there was an increase of only 2.9 S.D. (p < 0.05).Fig 7 and 8. Please see Table 3. In area 40 of Brodmann 3.3 and 2.1 in the right and left hemispheres respectively. In the frontal executive cortex there was an increase in the right areas 6, 8, 9, and 10 of 3.2, 3.8, 3.7 and 3.9 S.D. above the normal mean while the matching values in the left areas 6, 8, 9 and 10 were 2.6, 3.1, 3.9 and 3.8 respectively. The inhibition of function in temporal lobes was suggested by a Minimum Perfusion results in the right temporal lobe; areas 21, 22 and 38 of -2.3, -3.0 and -3.2 and in the left areas 21, 22 and 38 there were similar results. Please see Table 2.
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Figure 7. Normal Control. Auditory Experimental Activation.
There is marked increased function in Right temporal-parietal area, both frontal lobes, and diminution of function in lateral temporal lobes and cyngulate gyri.
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Figure 8. Same control. Areas of .
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We can conclude that in both the patient with auditory hallucinations and the normal controls activated with pure tones, there was a marked hyperperfusion in the right area 39 of Brodmann (Figure 6 and 8) statistically significant (p < 0.05) as compared with the left area 39 (Table 3). With a lesser intensity there was activation in the adjacent area 40 and there was intense activation also in the executive frontal cortex; areas 6, 8, 9 and 10 of Brodmann. There was also activation of area 7 of Brodmann. This is an audio-visual association area more intense in the right area 7 and the left area 7 in the patient with hallucinations and the normal controls of 3.9 and 3 S.D. above the normal mean and of 3.8 and 3.5 in the normal controls respectively. (Table 2).
Table 3.
CONTROLS
Statistical significance Maximum
| - |
LEFT.ROI
|
RIGHT.ROI
|
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Area 39
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3,5
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4,1
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| - |
3,6
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4,1
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| - |
2,5
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4,2
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| - |
2,2
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3,4
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| p Value |
0,045709839
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-
|
| - |
| - |
LEFT.ROI
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RIGHT.ROI
|
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Area 40
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2,9
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4,3
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| - |
2,8
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2,9
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| - |
2,1
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4,7
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| - |
0,8
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1,6
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| p Value |
0,202468709
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-
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In the sub cortical structures there was also marked activation in the patient with hallucinations in both lentiform nucleus, thalamus and caudate nucleus also more intense in the right hemisphere 5, 4.7 and 4.2 S.D. above the normal mean respectively and 5, 3.3 and 3 S.D. above the normal mean in the left hemisphere respectively. Similar findings were observed in the normal controls. Please see Table 2.
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