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Reduced perfusion in the anterior cingulate cortex of patients with pure autonomic failure: an 123I-IMP SPECT study
  1. S Hirano1,
  2. M Asahina1,
  3. Y Uchida2,
  4. H Shimada1,
  5. R Sakakibara2,3,
  6. H Shinotoh4,
  7. T Hattori1
  1. 1
    Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
  2. 2
    Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
  3. 3
    Department of Neurology, Toho University Sakura Medical Center, Chiba, Japan
  4. 4
    Asahi Hospital for Neurological Diseases, Chiba, Japan
  1. Correspondence to Dr S Hirano, Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan; stimulus{at}


Background: Pure autonomic failure (PAF) is a selective peripheral disorder in which Lewy bodies form within the autonomic ganglia. Patients with this disorder usually have no central lesions; however, chronic autonomic failure may secondarily affect the central nervous system. This study evaluated brain perfusion in patients with PAF by using N-isopropyl-p-123I iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT).

Methods: Six patients with PAF (all men; mean (SD) age 68±5 years) who had experienced autonomic symptoms for more than 5 years and six age-matched healthy control subjects (all men; mean (SD) age 67±5 years) were included in this study. The regions of interest (ROI) on spacially normalized 123I-IMP SPECT images were automatically computed for both groups.

Results: Perfusion of the dorsal anterior cingulate cortex was decreased in the PAF group compared with the healthy control group (0.93 vs 1.01; p<0.001). In the other brain regions measured, there was no significant difference in regional perfusion between the two groups.

Conclusions: The dorsal anterior cingulate cortex is poorly perfused and may be functionally altered in patients with PAF. The reduced perfusion in such individuals may be a secondary change that results from chronic autonomic failure.

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  • Competing interests None.