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A 54-year-old male presented in the department of neurology with cognitive-amnestic deficits and episodes of dystonic spasms in the left hand. In 2020, the patient had a right basal ganglia hemorrhage accompanying a paresis of the left hand. Due to the paresis, he was not able to define the exact symptom onset of the dystonic spasms. Cerebrospinal fluid (CSF) diagnostics (05/2023) showed an increase in total tau as well as phospho-tau. Amyloid-ß-1-42 was within normal range. The patient was suspected to suffer from a corticobasal syndrome and a tau-PET/CT scan was performed.
Tau-PET/CT imaging ([18F]PI-2620, 0–75 min. p. i.) revealed a higher radiotracer-uptake mainly in the right thalamus extending towards the right striatum/globus pallidus compared to the left side. No further tau-retention was detected. High spatial correspondence between the location of the intracerebral hemorrhage and the increased [18F]PI-2620-PET uptake was observed.
Tau-PET is employed for the detection of neurodegenerative tauopathies, particularly Alzheimer’s disease (AD). In AD, predominantly cortical distribution patterns are observed [1]. For second-generation tau-PET tracers like [18F]PI-2620, potential diagnostic value to detect non-AD tauopathies such as progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD) has been discussed [2]. In these disorders, basal ganglia uptake of the tracer is expected. However, post-mortem analyses have shown that tau-deposition can also occur after ischemic or hemorrhagic events [3]. This suggests that the tracer uptake observed in the current case, although specifically indicating tau-pathology may be the consequence of tissue damage following the intracerebral hemorrhage rather than of a neurodegenerative disease.
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References
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Acknowledgements
AD, GNB and EJ are funded by the Deutsche Forschungsgemeinschaft - Project-ID 431549029 - SFB 1451. OAO was funded by the Marga and Walter Boll-Foundation.
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Open Access funding enabled and organized by Projekt DEAL. Drafting of the manuscript was supported by an educational grant from Lilly.
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All authors contributed to the study conception and design. EJ, GB and AD drafted the manuscript and EJ, GB, OAO, MS and AD revised the manuscript. All authors read and approved the final manuscript.
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AD: Research support: Siemens Healthineers, Life Molecular Imaging, GE Healthcare, AVID Radiopharmaceuticals, Sofie, Eisai, Novartis/AAA, Ariceum Therapeutics. Speaker Honorary/Advisory Boards: Siemens Healthineers, Sanofi, GE Healthcare, Biogen, Novo Nordisk, Invicro, Novartis/AAA, Bayer VitalStock: Siemens Healthineers, Lantheus Holding, Structured therapeutics, ImmunoGen. Patents: Patent for 18 F-JK-PSMA- 7 (Patent No.: EP3765097A1; Date of patent: Jan. 20, 2021).
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Jaeger, E., Bischof, G.N., Onur, O.A. et al. Tau aggregation following subcortical hemorrhage. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06662-5
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DOI: https://doi.org/10.1007/s00259-024-06662-5