Brain perfusion asymmetry in patients with oral somatic delusions

Abstract

Oral cenesthopathy is a somatic delusion or hallucination involving the oral area and is categorized as a delusional disorder, somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using (99m)Tc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.

Fig. 1

^99mTc-ECD SPECT images of a patient with oral cenesthopathy (case no. 1 in Table 1). As compared with the values on the left side, the right temporal lobe and right frontal lobe show higher perfusion values

Fig. 2

‘R/(R + L) ratios’ for each brain area. A Mann–Whitney U test was used to compare the ‘R/(R + L) ratios’ for various areas of the brain between the control subjects and the patients. The X-axis shows each region, and the Y-axis shows the ‘R/(R + L) ratio’. The graphs on the left (gray bars) and the right (white bars) show the mean ± SD for the control subjects and the patients, respectively. The ROIs with a significant difference of the ratio are denoted by a single asterisk (P < 0.05)