Indian Pediatr 2011;48: 70-71
Cerebral Perfusion Abnormalities in Cases of
Sunil Kumar Gupta and B Venkat Ratnam
Krishna Ram Ayurvigyan Shodh Sansthan,
* Vardhman Nuclear Medicine
Anita Colony, Bajaj Nagar, Jaipur 302 015, India; and
SDM Hospital, Jaipur, India.
A SPECT (single photon emission computed tomography using Tc-99m HMPAO)
study of brain with segmental quantitative analysis was conducted to
access the cerebral perfusion in cases of Down’s syndrome (DS). Varying
level of brain hypo-perfusion was documented, probably explaining the
neurophysiologic basis of cognitive and neuropsychological deficits,
which are not well understood in DS.
Key words: Cognitive deficit, cerebral perfusion, SPECT,
Tc-99m HMPAO, neuropsychological deficits.
The neurophysiologic basis for these
cognitive deficits (mental retardation, deficit in language and memory
etc.) in down syndrome still remains poorly understood. Autopsy on these
cases have reported decrease in the spinous processes of apical dendrites
of the pyramidal neurons , lack of granular cells , early appearance
of neurofibrillary tangles, senile plaques or both at the age of 30-40
years, and, incomplete or delayed myelination in some cerebrocortical
regions viz. frontotemporal lobes and in cerebellocortex, especially in U
fibers . In general there is an overall decrease in metabolic need of
oxygen to maintain the resting membrane potentials and hence, decrease, in
cerebral perfusion [3-5]. Therefore, we conducted SPECT HMPAO study to
assess the quantitative segmental cerebral perfusion in cortical and
subcortical areas of brain in children with Down Syndrome.
We enrolled 10 patients with Down’s syndrome (proved
trisomy 21 on karyotyping) with 5 age matched control with mean age of 6 ±
1.5 years (4.5-8 years). In both groups, only those children were
selected, whose EEG and MRI were normal. Informed consent was taken from
parents. The study was approved by
the Ethical Clearance Committee of Krishna Ram Ayurvigyan Shodh Sansthan (KRASS).
The patients were evaluated by SPECT  using
Technetium-99m d, l, hexamethylpropyleneamine
oxime [99mTc] HMPAO. Analysis was conducted for perfusion studies using
segmental quantitative method (Xeleris brain SPECT segmental analysis
The results revealed a lower count values (30 to 45) in
cases,as compared to control group (75-85), indicating a generalized
perfusion abnormality in cases of DS (P<0.05). The
fronto-parieto-temporal region showed comparatively lower perfusion in
comparison to other areas of brain in cases. Lower perfusion was also
observed in subcortical areas.
Review of literature reported lowered cerebral
perfusion in fronto-parieto-temoporal region and reduced cortical activity
in Down Syndrome [3-5]. A correlation between the degree of cerebral
hypoperfusion in DS and retarded developmental was also reported,
especially in personal-social and
fine motor skills (such as stereotypic movements and echophenomena). The
altered perfusion in left medial prefrontal cortex was associated with
impairments in communication and social interaction [7,8] and altered
perfusion in left anterior cingulate gyrus was associated with impairments
in communication, social interaction and obsessive desire for sameness
. Sears, et al.  reported stereotyped and ritualistic
behavior due to subcortical dysfunction, whereas poor functioning of
paleocortically derived regions of the thalamus and basal ganglia were
associated with defect in response modulation, planning, sequencing and
This study provides a direction to understand the
mechanism of cognitive dysfunction, abnormal responses to sensory stimuli,
obsessive desire for same-ness, impairment in communication
and social interaction observed in children with Down syndrome.
Competing interests: None stated.
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