TC-99M-HMPAO BRAIN SPECT IMAGING IN A CASE OF REPEATED SYNCOPAL EPISODES ASSOCIATED WITH SMOKING

Background We report here a rare case of repeated syncopal episodes as sociated with smoking and findings of (99m)-Tc-hexamethylpropyleneamin e oxime (HMPAO) brain single-photon emission CT (SPECT) imaging. Case Description A 77-year-old man had four syncopal episodes during a half -month period. All four occurred when he stood up and walked immediate ly after smoking a cigarette, and syncope did not occur after cessatio n of smelting. Although upright testing revealed orthostatic hypotensi on, the patient did not complain of fainting on standing alone. Compar ed with brain SPECT in the supine position, perfusion was decreased in the posterior circulation structures after the subject smoked a cigar ette or chewed nicotine gum. Conclusions The combination of cerebral v asoconstriction due to smoking and orthostatic hypotension probably de creased cerebral blood flow in this patient, resulting in syncope.