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CC BY-NC-ND 4.0 · World J Nucl Med 2021; 20(01): 96-98
DOI: 10.4103/wjnm.WJNM_22_20
Case Report

Localizing a metabolic focus during a functional seizure with fluorodeoxyglucose positron emission tomography-computed tomography

Siroos Mirzaei
1   Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria
2   Hemayat, Organisation for Support of Victims of Torture and War, Vienna, Austria
,
Barbara Preitler
2   Hemayat, Organisation for Support of Victims of Torture and War, Vienna, Austria
,
Thomas Wenzel
3   Department of Psychiatry, Medical University of Vienna, Vienna, Austria
4   World Psychiatric Association Section of Psychological Aspects of Torture and Persecution, Geneva, Switzerland
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Abstract

Traumatic brain injuries can lead to long-term mental seizures that are difficult to differentiate from dissociative psychogenic symptoms, respectively, psychogenic nonepileptic seizures. Recent articles have drawn attention to the need of differentiation of psychological and brain trauma-related symptoms in survivors of violence. This case study reflects a diagnostic step in a 20-year-male who reported to have been subjected to torture, including blunt force to the head 2 years before examination. He suffers from episodical headaches followed by mental bouts of aggression and restlessness. We performed a brain 18F-fluorodeoxyglucose positron emission tomography (PET)-computed tomography to identify a cerebral correlate of the psychogenic seizures. The examination yielded a hypermetabolic focus in the frontal superior parasagittal region. Psychogenic seizures can frequently be observed as culture-specific “idioms of distress” and can challenge diagnostic evaluation, especially in the victims of violence with an additional history of blunt brain trauma. The advances in molecular imaging such as PET can be expected to play a crucial role in forensic and clinical assessment in the increasing number of such patients.

Keywords

Brain imaging - fluorodeoxyglucose positron emission tomography - functional seizures - posttraumatic stress disorder - torture

Financial support and sponsorship

Nil.




Publication History

Received: 02 April 2020

Accepted: 04 April 2020

Article published online:
30 March 2022

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Auxéméry Y, Hubsch C, Fidelle G. Psychogenic non epileptic seizures: A review. Encephale 2011;37:153-8.
  • 2 Keatley E, d'Alfonso A, Abeare C, Keller A, Bertelsen NS. Health outcomes of traumatic brain injury among refugee survivors of torture. J Head Trauma Rehabil 2015;30:E1-8.
  • 3 Alemi Q, James S, Cruz R, Zepeda V, Racadio M. Psychological distress in afghan refugees: A mixed-method systematic review. J Immigr Minor Health 2014;16:1247-61.
  • 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-5. 5th ed. Washington DC: American Psychiatric Association; 2013.
  • 5 Meltzer CC, Adelson PD, Brenner RP, Crumrine PK, Van Cott A, Schiff DP, et al. Planned ictal FDG PET imaging for localization of extratemporal epileptic foci. Epilepsia 2000;41:193-200.
  • 6 Auxéméry Y, Hubsch C, Fidelle G. Psychogenic non epileptic seizures: A review. Encephale 2011;37:153-8.
  • 7 Keatley E, d'Alfonso A, Abeare C, Keller A, Bertelsen NS. Health outcomes of traumatic brain injury among refugee survivors of torture. J Head Trauma Rehabil 2015;30:E1-8.
  • 8 Im H, Ferguson A, Hunter M. Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement. Transcult Psychiatry 2017;54:626-52.