Relative Brain Perfusion Findings in a Patient With Persistent Cognitive and Neuropsychiatric Symptoms: A Case Report

Binh Pham DO MPH MS^1,

¹Amen Clinics, Costa Mesa, USA

Cite this paper:
Binh Pham DO MPH MS. Relative Brain Perfusion Findings in a Patient With Persistent Cognitive and Neuropsychiatric Symptoms: A Case Report. American Journal of Medical Case Reports. 2026; 14(10):88-91. doi: 10.12691/ajmcr-14-10-3

Abstract

An adult man presented with several years of persistent fatigue, cognitive dysfunction, chronic pain, anxiety, depressive symptoms, and substantial functional impairment. He reported a prior diagnosis of Lyme disease and prolonged treatment, although documentation establishing the original diagnosis was unavailable. Subsequent infectious evaluation did not establish an active infectious etiology, and structural brain magnetic resonance imaging was reportedly unrevealing. Resting brain perfusion single-photon emission computed tomography demonstrated relatively decreased tracer activity involving bilateral temporal and occipital regions, the medial anterior prefrontal cortex, bilateral inferior orbitofrontal regions, and bilateral internal cerebellar regions, with relatively increased activity in the bilateral basal ganglia and thalami. These findings reflected qualitative interpretation of relative regional tracer distribution and were not used independently to establish diagnosis or etiology. Prior COVID-19 infection, sleep disturbance, chronic pain, psychiatric symptoms, stimulant exposure, caffeine use, and kratom use represented additional potential contributors. This case illustrates the descriptive role of brain perfusion SPECT in persistent cognitive and neuropsychiatric symptoms of uncertain and likely multifactorial origin.

Keywords:
brain perfusion SPECT cognitive symptoms neuropsychiatric symptoms fatigue Lyme disease COVID-19

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References:

[1]	Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021; 72: e1-e48.
[2]	Šegždaitė G, Aliukonytė O, Pociūtė K. Neuropsychiatric manifestations of Lyme disease: a literature review of psychiatric and cognitive impacts. Acta Med Litu. 2025; 32: 6-21.
[3]	Touradji P, Aucott JN, Yang T, et al. Cognitive decline in post-treatment Lyme disease syndrome. Arch Clin Neuropsychol. 2019; 34: 455-465.
[4]	Ceban F, Ling S, Lui LMW, et al. Fatigue and cognitive impairment in post-COVID-19 syndrome: a systematic review and meta-analysis. Brain Behav Immun. 2022; 101: 93-135.
[5]	Kapucu OL, Nobili F, Varrone A, et al. EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2. Eur J Nucl Med Mol Imaging. 2009; 36: 2093-2102.
[6]	Logigian EL, Johnson KA, Kijewski MF, et al. Reversible cerebral hypoperfusion in Lyme encephalopathy. Neurology. 1997; 49: 1661-1670.
[7]	Dersch R, Torbahn G, Rauer S. Treatment of post-treatment Lyme disease symptoms: a systematic review. Eur J Neurol. 2024; 31: e16293.
[8]	Donta ST, Noto RB, Vento JA. SPECT brain imaging in chronic Lyme disease. Clin Nucl Med. 2012; 37: e219-e222.