A 27-year-old neurologically disabled but fully conscious malezolpidem-responder patient was investigated for blood-brainbarrier (BBB) dysfunction 5 years after a traumatic brain injury. Abaseline single-photon emission computed tomography (SPECT)technetium-99m-labelled hexamethylpropylene amine oxime(99mTcHMPAO) brain scan was performed and the patient wasadministered 10 mg zolpidem daily. The patient was rescanned 2weeks later when 99mTcHMPAO was injected 1 hour after zolpidemapplication. SPECT technetium-99m-labelled diethylene-triaminepentaceticacid (99mTcDTPA) BBB scans were also performed beforeand after zolpidem treatment. There was decreased uptake of99mTcHMPAO in the left frontoparietal brain region, left temporalregion and left thalamus on baseline scanning; this improvedwithin 1 hour after zolpidem treatment at the follow-up scan. The99mTcDTPA scan remained within normal limits before and afterzolpidem treatment. The patient’s neurological disabilities, especiallycoordination, speech and gait, improved markedly. The Barthelindex remained normal, but the Tinetti falls efficacy scale improvedfrom 21/100 to 15/100. The results implied that the underlyingcause for the patient’s long-term neurological disability and brainsuppression was not due to a long-term dysfunctional BBB.
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