Abstract:
A 27-year-old neurologically disabled but fully conscious male
zolpidem-responder patient was investigated for blood-brain
barrier (BBB) dysfunction 5 years after a traumatic brain injury. A
baseline single-photon emission computed tomography (SPECT)
technetium-99m-labelled hexamethylpropylene amine oxime
(99mTcHMPAO) brain scan was performed and the patient was
administered 10 mg zolpidem daily. The patient was rescanned 2
weeks later when 99mTcHMPAO was injected 1 hour after zolpidem
application. SPECT technetium-99m-labelled diethylene-triaminepentacetic
acid (99mTcDTPA) BBB scans were also performed before
and after zolpidem treatment. There was decreased uptake of
99mTcHMPAO in the left frontoparietal brain region, left temporal
region and left thalamus on baseline scanning; this improved
within 1 hour after zolpidem treatment at the follow-up scan. The
99mTcDTPA scan remained within normal limits before and after
zolpidem treatment. The patient’s neurological disabilities, especially
coordination, speech and gait, improved markedly. The Barthel
index remained normal, but the Tinetti falls efficacy scale improved
from 21/100 to 15/100. The results implied that the underlying
cause for the patient’s long-term neurological disability and brain
suppression was not due to a long-term dysfunctional BBB.
