FDG-PET and IBZM-SPECT Suggest Reduced Thalamic Activity but No Dopaminergic Dysfunction in Chronic Alcohol Hallucinosis
Case Report
Mrs. A., a 35-year-old housewife with a long-term alcohol history of at least a decade with an average alcohol consumption of 400 g of alcohol per day, suffered from vivid and continuing auditory and recurrent visual hallucinations, fear, sleep disturbances, and mild delusions of persecution for a year. There was no evidence for any schizophrenic thought disorder or blunted affect, psychotic ego disturbances, or disturbances of orientation or consciousness. Auditory hallucinations also persisted in phases of reduced alcohol consumption or abstinence. The patient had never received any psychotropic medication before admission. At admission the patient was found to have elevated liver enzymes (serum gamma-glutamyl transaminase 180 U/l) and showed mild withdrawal symptoms. Hallucinations persisted over a period of 6 weeks following abstinence, despite later treatment with neuroleptics (flupentixol 10 mg/day).Neurologic examination did not show any abnormal finding. Magnetic resonance imaging revealed a generalized cortical brain atrophy without any evidence for focal gray or white matter lesions. CSF and chest X-ray were normal. [123I]iodobenzamide (IBZM) SPECT was performed after 2 weeks of abstinence in the drug-naive patient on a triple-head gamma camera (Picker Prism 3000 XP, equipped with high-resolution fan beam collimators) after iv administration of 185 MBq [123I]IBZM. Images were acquired 2 hours after administration and were reconstructed by use of filtered backprojection. Finally, images were postfiltered by using a low-pass filter and attenuation corrected according to Chang's first-order method. The reconstructed scans displayed a homogeneous binding of the ligand to the postsynaptic dopamine D2 receptors. There was no evidence of any asymmetries or reduction of binding. The semiquantitative evaluation revealed a normal specific binding ([striatum–background]/background) of 0.8.
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