Brain 18F-FDG, 18F-Florbetaben PET/CT, 123I-FP-CIT SPECT and Cardiac 123I-MIBG Imaging for Diagnosis of a "Cerebral Type" of Lewy Body Disease

A 67-year-old man was referred for fluctuating neuropsychiatric symptoms, featuring depression, delirious episodes, recurrent visual hallucinations and catatonic syndrome associated with cognitive decline. No parkinsonism was found clinically even under neuroleptic treatment. 18F-FDG PET/CT showed hypometabolism in the posterior associative cortex including the occipital cortex, suggesting Lewy body dementia, but 123I-FP-CIT SPECT was normal and cardiac 123I-MIBG imaging showed no signs of sympathetic denervation. Alzheimer's disease was excluded by a normal 18F-florbetaben PET/CT. This report suggests a rare case of α-synucleinopathy without brainstem involvement, referred to as "cerebral type" of Lewy body disease