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(Stroke. 1997;28:1461-1463.)
© 1997 American Heart Association, Inc.

Articles

^99mTc-HMPAO Brain SPECT Imaging in a Case of Repeated Syncopal Episodes Associated With Smoking

Hitoshi Fukuda, MD; Mitsuhiro Kitani, MD; Hiroki Omodani, MD

From the Departments of Neurology and Cardiovascular Disease (H.O.), Masuda Red Cross Hospital, Shimane, Japan.

Correspondence to Hitoshi Fukuda, MD, Department of Neurology, Masuda Red Cross Hospital, I103-1, Otoyoshi, Masuda, Shimane, 698, Japan.

Background We report here a rare case of repeated syncopal episodes associated with smoking and findings of ^99mTc–hexamethylpropyleneamine 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 immediately after smoking a cigarette, and syncope did not occur after cessation of smoking. Although upright testing revealed orthostatic hypotension, the patient did not complain of fainting on standing alone. Compared with brain SPECT in the supine position, perfusion was decreased in the posterior circulation structures after the subject smoked a cigarette or chewed nicotine gum.

Conclusions The combination of cerebral vasoconstriction due to smoking and orthostatic hypotension probably decreased cerebral blood flow in this patient, resulting in syncope.

Key Words: cerebral blood flow • cigarette smoking • syncope • tomography, emission computed

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