RESUMO
BACKGROUND: Combined measurements on conventional magnetic resonance imaging (MRI), such as midbrain area/pons area or magnetic resonance parkinsonism index (MRPI) (pons area/midbrain area × middle cerebellar peduncle width/superior cerebellar peduncle width), have been proposed as powerful tools in the differential diagnosis between progressive supranuclear palsy (PSP) and Parkinson disease (PD). In this study, we evaluated the accuracy of MRPI, compared with midbrain/pons ratio, in distinguishing PSP from probable and possible PD. METHODS: Forty-two PSP patients, 170 probable PD patients, 132 possible PD patients, and 38 control subjects underwent MRI and, for each patient, midbrain/pons ratio and MRPI were calculated. RESULTS: Midbrain/pons ratio showed low accuracy in distinguishing PSP patients from those with probable PD (92.9% sensitivity; 85.3% specificity; 86.8% diagnostic accuracy) or those with possible PD (88.1% sensitivity, 88.3% specificity, and 88.2% diagnostic accuracy) and control subjects (97.6% sensitivity, 92.1% specificity, and 95% diagnostic accuracy). By contrast, MRPI showed higher accuracy to distinguish PSP from probable PD (100% sensitivity, 99.4% specificity, and 99.5% diagnostic accuracy), from possible PD (100% sensitivity, 99.2% specificity, and 99.4% diagnostic accuracy), and from control subjects (sensitivity, specificity, and diagnostic accuracy of 100%). CONCLUSIONS: Our study confirms that MRPI is a more accurate measure than midbrain/pons ratio for differentiation of patients with PSP from those with probable and possible PD.
Assuntos
Diagnóstico Diferencial , Imageamento por Ressonância Magnética/métodos , Doença de Parkinson/diagnóstico , Paralisia Supranuclear Progressiva/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Mapeamento Encefálico , Tronco Encefálico/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
We report a 26-year-old woman admitted to our hospital for generalized tonic seizure. Laboratory investigations revealed severe hyponatremia possibly triggered by vomiting and diarrhea. 24 hours after correction of hyponatremia she developed diffuse myalgias and marked hyperCKemia. Syndrome of inappropriate antidiuresis (SIAD) was suspected as cause of hyponatremia. Abnormal vaginal bleeding prompts gynecological evaluation and a small-cell carcinoma of uterine cervix was detected.