How do you know unless you look?

SPECT looks at blood flow and activity patterns. It looks at how your brain works. We typically obtain two scans on patients - one at rest and the other during concentration. The images below are examples of the various SPECT patterns associated with different disorders and brain types.


Is Premenstrual Syndrome Real? You Bet!

Over the years, we have scanned many women with PMS just before the onset of their period (the worst time of their cycle) and then again a week after the start of their period (the best time of their cycle). When PMS is present, we see dramatic differences between the scans:

  • When a woman feels good, her deep limbic system is calm and cool, and she has good activity in her temporal lobes and prefrontal cortex
  • Right before her period when she feels the worst, her deep limbic system is often overactive and she has poor activity in her temporal lobes and prefrontal cortex

We’ve observed three common PMS patterns on SPECT. One is focal increased deep limbic activity often accompanied by temporal lobe hypoperfusion, correlating with cyclic mood changes. When the limbic system is more active on the left side, symptoms tend to include anger, irritability and expressed negative emotion. When it is more active on the right side, it is often associated with sadness, emotional withdrawal, anxiety and repressed negative emotion.

The second PMS pattern we have observed on SPECT is increased deep limbic activity in conjunction with increased anterior cingulate gyrus activity. Women with this pattern often complain of increased sadness, worrying, repetitive negative thoughts and verbalizations (nagging) and cognitive inflexibility.

We also frequently see decreased or lower prefrontal cortex activity during the worst time of the cycle that improves—sometimes considerably—during the best time of the cycle.

PMS Case Studies

Haley is a 12-year-old girl who presented to the clinic with violent mood swings, aggressive behavior, prolonged tantrums, depression and oppositional behavior. Her symptoms primarily occur several days before and after the onset of her menstrual cycle. Within the first week after the start of her period, she is markedly improved, more compliant, more positive and easier to get along with. In order to help understand the underlying physiological abnormalities in her brain, a SPECT series was performed during the worst time of her cycle (day 3) and during the best time of her cycle (day 10).

Haley’s SPECT study during the worst time of her cycle was very abnormal with marked overactivity of the anterior cingulate gyrus (associated with obsessive thinking and problems shifting attention), significant decreased temporal lobe activity (associated with aggressive thoughts, hypersensitivity to others, memory problems and mood instability) and marked decreased prefrontal cortex activity (associated with problems of impulsivity, attention span and self-supervision).

The SPECT study during the best time of her cycle markedly improved with calming of the cingulate activity and improved function in the temporal lobes and prefrontal cortex.

Andrea is a 25-year-old female who has been diagnosed with severe PMS and ADD. Seven to ten days before the onset of her menstrual cycle she experiences moodiness, irritability, hypersensitivity to others, anxiety and increased alcohol consumption. These symptoms decrease significantly several days after the onset of her menstrual period.

Danielle was a 33-year-old, married female referred for evaluation because of suicidal thoughts, depression, anxiety and irritability. These problems occurred predominantly during the last week of her menstrual cycle and significantly remitted several days after the onset of her period. Danielle and her husband confirmed the cyclic changes in her symptoms.

Danielle was scanned on day 25 of a 28-day cycle when she was experiencing severe agitation and moodiness. Her SPECT study revealed significant, increased activity in the anterior and central cingulate gyrus and in the right basal ganglia. Also, there was decreased activity in the prefrontal cortex and left temporal lobe.

She was then scanned on day 10 of the next menstrual cycle, when she was symptom free. Her follow-up scan revealed improved calming of the cingulate and right basal ganglia overactivity, and improved activity in the prefrontal cortex and left temporal lobe. With the correct treatment, she was still symptom free during her premenstrual period 3 years later.

Michelle, a 35-year-old nurse, left her husband on three separate occasions. Each time she left him, it happened within ten days before the onset of her menstrual period. The last time, her irritability, anger and irrational behavior escalated to the point where she attacked him with a knife over a minor disagreement.

Michelle came to the clinic several days after her period started and her symptoms had settled down significantly. Her severe temper outbursts were usually over by the third day after her period started. She appeared to be a gentle, soft-spoken woman so it was hard to imagine that this woman had, only days before, gone after her husband with a carving knife.

Because her actions were so serious, two brain SPECT studies were completed: The first one was done 4 days before the onset of her next period – during the roughest time in her cycle – and the second one was done 11 days later – during the best time of her cycle.

We have observed that left-sided brain problems often correspond with a tendency toward significant irritability and even violence. On Michelle’s premenstrual brain study, before the onset of her period, her limbic system (the mood control center) near the center of her brain was significantly overactive, especially on the left side. This “focal” limbic finding (on one side as opposed to both sides) often correlates with cyclical tendencies toward depression and irritability. There was a dramatic change in her second scan taken eleven days later when Michelle was feeling better. The limbic system was normal!


If you want to speak to someone immediately, you can call a qualified Patient Care Coordinator with Amen Clinics. We can start to answer your questions and help you book a Full Evaluation with Amen Clinics. Call Today! 888-208-0037

Book an evaluation

Have a Question?