Q. MY 9 YEAR SON HAD A SPECT SCAN-THIS WAS THE FINDINGS: EVALUATION OF 3D SURFACE IMAGES DEMONSTRATES MARKED DECREASE IN THE ACTIVITY IN THE TEMPORAL LOBES, RIGHT GREATER THAN LEFT. THIS IS PARTICULARLY SEVERE IN THE LATERAL ASPECT OF THE RIGHT TEMPORAL LOBE, EXPENDING TOWARD THE INFERIOR POSTERIOR ASPECT OF THE RIGHT PARIETAL LOBE. THERE IS ALSO DECREASED ACTIVITY DEMONSTRATED WITHIN THE LEFT INFRAORBITAL CORTEX MEDIALLY.

3D ACTIVE IMAGES DEMONSTRATES INCREASED CORTICAL ACTIVITY DIFFUSELY. THIS IS ESPECIALLY PROMINENT IN THE FRONTAL REGIONS AND THE LEFT PARIETAL REGION. THIS APPEARANCE HAS BEEN TERMED THE RING OF FIRE. TOMOGRAPHIC IMAGES DEMONSTRATE ABNORMAL INCREASED ACTIVITY IN A PATCHY DISTRIBUTION THROUGHOUT THE CEREBRAL CORTEX WITH MARKEDLY DECREASED ACTIVITY DEMONSTRATED IN THE INFERIOR AND POSTERIOR RIGHT PARIETAL LOBE AND THE LATERAL ASPECT OF THE RIGHT TEMPORAL LOBE ANTERIORLY. THERE IS MILDLY DECREASED ACTIVITY DEMONSTRATED IN THE INFERIOR ORBITAL CORTEX ON THE RIGHT POSTEROMEDIALLY.

IMPRESSION: THE MOST SIGNIFICANT FINDING ON THE STUDY IS THE RING OF FIRE PATTERN WITH PATCHY UPTAKE ACROSS THE CORTICAL SURFACE. THIS HAS BEEN DESCRIBED IN PATIENTS WITH BIPOLAR DISORDER AND EXPLOSIVE OR AGGRESSIVE OUTBURSTS. IN ADDITION, THERE IS THE FOCAL AREA OF MODERATELY DECREASED ACTIVITY, INVOLVING THE RIGHT POSTERIOR INFERIOR PARIETAL AND ANTERIOR SUPERIOR TEMPORAL LOBES. THIS MAY BE FROM OLD TRAUMA. GIVEN THIS CONSTELLATION OF FINDINGS, IF THE CLINICAL SYMPTOMS WARRANT, ONE MIGHT CONSIDER A MEDICATION SUCH AS TENEX OR CLONIDINE TO DECREASE THE DIFFUSE CORTICAL HYPERACTIVITY. ADDITIONALLY, BECAUSE OF THE ABNORMALITY INVOLVING THE TEMPORAL LOBES YOU MAY WISH TO CONSIDER AN ANTICONVULSANT TO STABILIZE TEMPORAL LOBE FUNCTION AND CALM IRRITABILITY. END OF REPORT.......

WE DO NOT KNOW OF ANY TRAUMA HE HAS HAD THROUGHOUT HIS LIFE. ANY INSIGHT OR GENERAL DESCRIPTION OF THIS REPORT (WORDS WE CAN UNDERSTAND BETTER) WOULD BE HELPFUL. OUR NEUROLOGIST HAS REFERRED HIM TO A CHILD PSYCHIATRIST FOR EVALUATION OF WHICH MEDICATIONS WE SHOULD PUT HIM ON. ALSO, CAN YOU TELL US WHEN WE PUT HIM ON THESE MEDICATIONS WILL HE HAVE TO BE ON THEM FOR THE REST OF HIS LIFE IN ORDER TO CONTROL THESE SYMPTOMS? WE HAVE BEEN TOLD HE HAS A LEARNING DEFICIT CALLED (A VISUAL DEFICIT) WHICH AFFECTS HIS LEARNING ABILITY...DO YOU SEE THIS IN THE REPORT OF THIS BRAIN SPECT SCAN? WILL HIM TAKING THE 2 MEDICATIONS HELP HIS LEARNING POTENTIAL?

WE UNDERSTAND THAT WE NEED TO ASK ALL OF THESE QUESTIONS TO THE DOCTORS HE IS YET TO SEE, HOWEVER, WE WOULD APPRECIATE YOUR EXPERTISE, ADVICE OR SUGGESTIONS-- SO WE KNOW IF WE ARE GOING IN THE RIGHT DIRECTION TO HELP OUR SON.

  A. You are in good hands already. Your neurologist can handle all the medical problems, and the child psychiatrist the psychiatric ones. The scan is a test, and open to many interpretations. Let your current doctors do their work, and all should improve. Honestly, everything done so far is textbook good treatment. Hopefully, the outcome will be favorable, too, longitudinally.