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2.
Intern Med ; 59(4): 485-490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32062624

RESUMO

Objective When patients take neuroleptics, the distinction between Parkinson's disease (PD) and drug-induced parkinsonism (DIP) based solely on clinical features can become difficult. At present, 123I-FP-CIT SPECT (DAT-SPECT) and 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy are widely used to supplement the differential diagnosis of parkinsonism. This study assessed the clinical symptoms and neurological findings in the patients suspected of having DIP based on DAT-SPECT findings. Methods Twenty-three patients (11 men, 12 women, age: 52-81 years old) presenting with DIP were recruited. All patients underwent neurological examinations, including brain magnetic resonance imaging and DAT-SPECT. Patients who showed abnormal DAT-SPECT results underwent MIBG myocardial scintigraphy. Results Eleven patients showed a reduction in the ligand uptake on DAT-SPECT (DAT-positive group), and nine of these patients showed a low delayed heart-to-mediastinum (H/M) ratio on MIBG myocardial scintigraphy. The remaining 12 patients showed normal results on DAT-SPECT (DAT-negative group). All patients in the DAT-positive group had asymmetric motor symptoms, whereas only 4 in the DAT-negative group exhibited this clinical feature (p=0.001). A detailed medical history showed that 7 of the 11 patients in the DAT-positive group had prodromal symptoms for PD. However, only 1 patient in the DAT-negative group exhibited these symptoms (p= 0.009). Although two patients in the DAT-negative group showed poor improvement, they showed a normal H/M ratio on MIBG and no response to levodopa. Conclusion The patients in the DAT-positive group might have prodromal symptoms that were worsened by neuroleptic drugs. The results of detailed history-taking and neurological findings seem to indicate cases of compromised dopaminergic transmission before the administration of neuroleptic drugs.


Assuntos
Antipsicóticos/efeitos adversos , Neuroimagem Funcional/métodos , Doença de Parkinson Secundária/induzido quimicamente , Doença de Parkinson/diagnóstico por imagem , Transtornos Parkinsonianos/induzido quimicamente , Transtornos Parkinsonianos/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Sintomas
3.
Life Sci ; 240: 117091, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31760102

RESUMO

Mounting evidences indicated that elevated iron levels in the substantia nigra (SN) have been concerned as the underlying mechanisms of neurodegenerative diseases, including Parkinson's disease (PD). The present study used the 1-Methyl-4-phenyl-1, 2, 3, 6 -tetrahydropyridine (MPTP)-treated cynomolgus monkeys for PD to evaluate the usability of SWI for assessing iron deposition in the cerebral nuclei of PD. The results showed that susceptibility-weighted imaging (SWI) phase values of the ipsilateral (MPTP-lesion side) SN of MPTP-treated monkeys were lower than those in the contralateral SN of MPTP-treated monkeys and the same side of Control monkeys, suggesting that iron deposition were elevated in the affected side SN of MPTP-treated monkeys. Whereas MPTP has not effects on the SWI phase values in other detected brain regions of monkeys, including red nucleus (RN), putamen (PUT) and caudate nucleus (CA). Furthermore, ICP-MS results showed that MPTP increased the iron levels in MPTP injection side, but no in the ipsilateral striatum. Additionally, MPTP treatment did not affect the calcium and manganese levels in the detected brain regions of monkeys. However, Pearson correlation analysis results indicated that there were not relationship between SWI phase values in MPTP-lesion side of SN with the behavioral score, tyrosine hydroxylase (TH)-positive cells number and iron levels in the MPTP-lesion side of midbrain. Taken together, the results confirm the involvement of SN iron accumulations in the MPTP-treated monkey models for PD, and indirectly verify the usability of SWI for the measurement of iron deposition in the cerebral nuclei of PD.


Assuntos
Ferro/metabolismo , Intoxicação por MPTP/metabolismo , Transtornos Parkinsonianos/metabolismo , Animais , Comportamento Animal , Encéfalo/diagnóstico por imagem , Cálcio/metabolismo , Intoxicação por MPTP/diagnóstico por imagem , Macaca fascicularis , Imagem por Ressonância Magnética , Masculino , Manganês/metabolismo , Espectrometria de Massas , Transtornos Parkinsonianos/induzido quimicamente , Transtornos Parkinsonianos/diagnóstico por imagem , Substância Negra/metabolismo , Substância Negra/patologia , Tirosina 3-Mono-Oxigenase/metabolismo
4.
Brain ; 143(1): 303-319, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31855245

RESUMO

Homozygous mutations in the progranulin gene (GRN) are associated with neuronal ceroid lipofuscinosis 11 (CLN11), a rare lysosomal-storage disorder characterized by cerebellar ataxia, seizures, retinitis pigmentosa, and cognitive disorders, usually beginning between 13 and 25 years of age. This is a rare condition, previously reported in only four families. In contrast, heterozygous GRN mutations are a major cause of frontotemporal dementia associated with neuronal cytoplasmic TDP-43 inclusions. We identified homozygous GRN mutations in six new patients. The phenotypic spectrum is much broader than previously reported, with two remarkably distinct presentations, depending on the age of onset. A childhood/juvenile form is characterized by classical CLN11 symptoms at an early age at onset. Unexpectedly, other homozygous patients presented a distinct delayed phenotype of frontotemporal dementia and parkinsonism after 50 years; none had epilepsy or cerebellar ataxia. Another major finding of this study is that all GRN mutations may not have the same impact on progranulin protein synthesis. A hypomorphic effect of some mutations is supported by the presence of residual levels of plasma progranulin and low levels of normal transcript detected in one case with a homozygous splice-site mutation and late onset frontotemporal dementia. This is a new critical finding that must be considered in therapeutic trials based on replacement strategies. The first neuropathological study in a homozygous carrier provides new insights into the pathological mechanisms of the disease. Hallmarks of neuronal ceroid lipofuscinosis were present. The absence of TDP-43 cytoplasmic inclusions markedly differs from observations of heterozygous mutations, suggesting a pathological shift between lysosomal and TDP-43 pathologies depending on the mono or bi-allelic status. An intriguing observation was the loss of normal TDP-43 staining in the nucleus of some neurons, which could be the first stage of the TDP-43 pathological process preceding the formation of typical cytoplasmic inclusions. Finally, this study has important implications for genetic counselling and molecular diagnosis. Semi-dominant inheritance of GRN mutations implies that specific genetic counselling should be delivered to children and parents of CLN11 patients, as they are heterozygous carriers with a high risk of developing dementia. More broadly, this study illustrates the fact that genetic variants can lead to different phenotypes according to their mono- or bi-allelic state, which is a challenge for genetic diagnosis.


Assuntos
Demência Frontotemporal/genética , Lipofuscinoses Ceroides Neuronais/genética , Transtornos Parkinsonianos/genética , Progranulinas/genética , Adolescente , Adulto , Idade de Início , Ataxia Cerebelar/genética , Criança , Disfunção Cognitiva/genética , Epilepsia/genética , Feminino , Demência Frontotemporal/diagnóstico por imagem , Demência Frontotemporal/fisiopatologia , Heterozigoto , Homozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Lipofuscinoses Ceroides Neuronais/diagnóstico por imagem , Lipofuscinoses Ceroides Neuronais/fisiopatologia , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/fisiopatologia , Progranulinas/metabolismo , Processamento de RNA/genética , Doenças Raras , Retinite Pigmentosa/genética , Proteinopatias TDP-43/diagnóstico por imagem , Proteinopatias TDP-43/genética , Proteinopatias TDP-43/fisiopatologia , Adulto Jovem
5.
Cells ; 9(1)2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31861253

RESUMO

The hyperechogenicity of the substania nigra (SN) has been established as a valid finding in patients with Parkinson´s disease (PD), probably caused by an increased tissue iron concentration in the SN. The application of transcranial sonography (TCS) has been investigated for further echogenic basal ganglia alterations in patients with extrapyramidal movement disorders. Compared to PD, a hyperechogenic nucleus lentiformis (LN) has been reported to appear more frequently in atypical parkinsonian syndromes (aPS) such as the parkinsonian phenotype of multiple system atrophy (MSA-P) or the progressive supranuclear palsy (PSP). As the evidence providing study sizes are small, we conduct the first meta-analysis of the prevalence of LN hyperechogenicity in PD and aPS. We search for available studies providing prevalence of LN hyperechogenicity in patients with PD and aPS (MSA-P and PSP) detected by TCS in MEDLINE and SCOPUS databases. We calculate the prevalence rates of LN hyperechogenicity detection in patients with clinical diagnosis of PD vs. aPS under the random-effects model. We include a total of 1330 patients, 1091 PD and 239 aPS (MSA-P and PSP). We find a significantly higher prevalence of LN hyperechogenicity in aPS (76%, 95% CI: 0.62-0.88) compared to PD (16%, 95% CI: 0.10-0.23). After proving a higher prevalence of LN hyperechogenicity in aPS compared to PD, its histopathological cause needs to be investigated. Furthermore, its full diagnostic accuracy and the qualification to serve as a risk factor for MSA-P and PSP should also be questioned in future studies.


Assuntos
Corpo Estriado/diagnóstico por imagem , Transtornos Parkinsonianos/classificação , Transtornos Parkinsonianos/diagnóstico por imagem , Corpo Estriado/patologia , Ecoencefalografia , Humanos , Transtornos Parkinsonianos/patologia , Prevalência
6.
Front Neural Circuits ; 13: 50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447651

RESUMO

An imbalance of iron metabolism with consecutive aggregation of α-synuclein and axonal degeneration of neurons has been postulated as the main pathological feature in the development of Parkinson's disease (PD). Quantitative susceptibility mapping (QSM) is a new imaging technique, which enables to measure structural changes caused by defective iron deposition in parkinsonian brains. Due to its novelty, its potential as a new imaging technique remains elusive for disease-specific characterization of motor and non-motor symptoms (characterizing the individual parkinsonian phenotype). Functional network changes associated with these symptoms are however frequently described for both magnetoencephalography (MEG) and resting state functional magnetic imaging (rs-fMRI). Here, we performed a systematic review of the current literature about QSM imaging, MEG and rs-fMRI in order to collect existing data about structural and functional changes caused by motor and non-motor symptoms in PD. Whereas all three techniques provide an effect in the motor domain, the understanding of network changes caused by non-motor symptoms is much more lacking for MEG and rs-fMRI, and does not yet really exist for QSM imaging. In order to better understand the influence of pathological iron distribution onto the functional outcome, whole-brain QSM analyses should be integrated in functional analyses (especially for the non-motor domain), to enable a proper pathophysiological interpretation of MEG and rs-fMRI network changes in PD. Herewith, a better understanding of the relationship between neuropathological changes, functional network changes and clinical phenotype might become possible.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Rede Nervosa/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Fenótipo , Descanso , Animais , Encéfalo/fisiopatologia , Humanos , Rede Nervosa/fisiopatologia , Transtornos Parkinsonianos/fisiopatologia , Descanso/fisiologia
7.
Neurol Neurochir Pol ; 53(4): 311-314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441498

RESUMO

AIM: Drug-induced parkinsonism (DIP) is the most common form of parkinsonism after Parkinson's disease (PD) itself. It has been widely believed that DIP is characterised by symmetry of symptoms. Studies of patients with DIP in whom PD had been ruled out by SPECT-DaTSCAN have shown that symptom asymmetry is a common element of DIP clinical presentation. The aim of our study was to determine whether the asymmetry of symptoms in DIP is related to any abnormality within the presynaptic part of the nigrostriatal dopaminergic system. MATERIALS AND METHODS: Eleven patients with the diagnosis of DIP and asymmetric symptoms were studied. Their individual SPECT-DaTSCANs were normal. Indices calculated for the whole group of radiotracer uptake in the whole striatum, putamen and caudate contralateral to more severe DIP symptoms were compared to values obtained in the opposite hemisphere. RESULTS: We did not find significant differences in radiotracer uptake in structures contralateral to more severe clinical symptoms when compared to the homolateral hemisphere. CONCLUSIONS: Our results have not confirmed the presence of a presynaptic nigrostriatal deficit which could be related to asymmetry of DIP. The factors responsible for the asymmetry of DIP symptoms should be sought in the postsynaptic part of the nigrostriatal dopaminergic system.


Assuntos
Transtornos Parkinsonianos , Proteínas da Membrana Plasmática de Transporte de Dopamina , Humanos , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
9.
Ann Neurol ; 86(4): 517-526, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31376168

RESUMO

OBJECTIVE: X-linked dystonia-parkinsonism (XDP) is a neurodegenerative disease with adult onset dystonia and subsequent parkinsonism. Postmortem and imaging studies revealed remarkable striatal pathology, with a predominant involvement of the striosomal compartment in the early phase. Here, we aimed to disentangle sequential neurodegeneration in the striatum of XDP patients, provide evidence for preferential loss of distinct striatal areas in the early phase, and investigate whether iron accumulation is present. METHODS: We used multimodal structural magnetic resonance imaging (voxel-based morphometry and relaxometry) in 18 male XDP patients carrying a TAF1 mutation and 19 age-matched male controls. RESULTS: Voxel-based relaxometry and morphometry revealed (1) a cluster in the anteromedial putamen showing high iron content and severe atrophy (-55%) and (2) a cluster with reduced relaxation rates as a marker for increased water levels and a lower degree of atrophy (-20%) in the dorsolateral putamen. Iron deposition correlated with the degree of atrophy (ρ = -0.585, p = 0.011) and disease duration (ρ = 0.632, p = 0.005) in the anteromedial putamen. In the dorsolateral putamen, sensorimotor putamen atrophy correlated with disease severity (ρ = -0.649, p = 0.004). INTERPRETATION: This multimodal approach identified a patchy pattern of atrophy within the putamen. Atrophy is advanced and associated with iron accumulation in rostral regions of the striatum, whereas neurodegeneration is moderate and still ongoing in dorsolateral areas. Given the short disease duration and predominant dystonic phenotype, these results are well in line with early and preferential degeneration of striosome-rich striatal areas in XDP. ANN NEUROL 2019;86:517-526.


Assuntos
Doenças dos Gânglios da Base/diagnóstico por imagem , Doenças dos Gânglios da Base/patologia , Distúrbios Distônicos/diagnóstico por imagem , Distúrbios Distônicos/patologia , Degeneração Neural/patologia , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/patologia , Adulto , Atrofia/patologia , Doenças dos Gânglios da Base/complicações , Doenças dos Gânglios da Base/metabolismo , Estudos de Casos e Controles , Distúrbios Distônicos/complicações , Humanos , Ferro/metabolismo , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Transtornos Parkinsonianos/complicações , Transtornos Parkinsonianos/metabolismo , Putamen/diagnóstico por imagem , Putamen/metabolismo , Putamen/patologia , Índice de Gravidade de Doença , Adulto Jovem
10.
Hum Brain Mapp ; 40(17): 5094-5107, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31403737

RESUMO

Neurite orientation dispersion and density imaging (NODDI) uses a three-compartment model to probe brain tissue microstructure, whereas free-water (FW) imaging models two-compartments. It is unknown if NODDI detects more disease-specific effects related to neurodegeneration in Parkinson's disease (PD) and atypical Parkinsonism. We acquired multi- and single-shell diffusion imaging at 3 Tesla across two sites. NODDI (using multi-shell; isotropic volume [Viso]; intracellular volume [Vic]; orientation dispersion [ODI]) and FW imaging (using single-shell; FW; free-water corrected fractional anisotropy [FAt]) were compared with 44 PD, 21 multiple system atrophy Parkinsonian variant (MSAp), 26 progressive supranuclear palsy (PSP), and 24 healthy control subjects in the basal ganglia, midbrain/thalamus, cerebellum, and corpus callosum. There was elevated Viso in posterior substantia nigra across Parkinsonisms, and Viso, Vic, and ODI were altered in MSAp and PSP in the striatum, globus pallidus, midbrain, thalamus, cerebellum, and corpus callosum relative to controls. The mean effect size across regions for Viso was 0.163, ODI 0.131, Vic 0.122, FW 0.359, and FAt 0.125, with extracellular compartments having the greatest effect size. A key question addressed was if these techniques discriminate PD and atypical Parkinsonism. Both NODDI (AUC: 0.945) and FW imaging (AUC: 0.969) had high accuracy, with no significant difference between models. This study provides new evidence that NODDI and FW imaging offer similar discriminability between PD and atypical Parkinsonism, and FW had higher effect sizes for detecting Parkinsonism within regions across the basal ganglia and cerebellum.


Assuntos
Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Neuritos , Doença de Parkinson/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Clin Neuropharmacol ; 42(5): 181-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361666

RESUMO

OBJECTIVE: The objective of this study was to report long-lasting effects of bupropion on brain dopamine transporter (DAT) in a patient with depression and parkinsonism. METHODS: The patient was a 52-year old man who had been treated with 150 mg/d of bupropion for depression. The patient developed cognitive problems, bradykinesia, and reduced stride length for which he was scanned with [I]FP-CIT single photon emission computed tomography after the recommended 1-week discontinuation of bupropion. Levodopa treatment trial was initiated without a response. Eleven months later, the patient was scanned for a second time after a 1-month stoppage of bupropion. RESULTS: The first scan was abnormal with left putamen specific binding ratio of 1.99 (SDs from the reference value mean, -2.40), right putamen of 2.27 (SD, -1.84), left caudate of 2.33 (SD, -2.26), and right caudate of 2.29 (SD, -2.18). The second scan (after 1-month discontinuation) was normal, and specific binding ratios had increased from 5.2% to 31.7% in all striatal regions as compared with the first scan. Brain magnetic resonance imaging and [F]fluorodeoxyglucose positron emission tomography imaging were normal, and there was no levodopa response or other features supporting neurodegenerative parkinsonism. CONCLUSIONS: Bupropion has previously generally been discontinued 1 week prior DAT imaging, which meets the recommended, albeit arbitrary, time interval of 5 plasma clearance half-lives before the scan. One-week discontinuation of bupropion before DAT imaging may be insufficiently short. Our case shows that longer medication washout and rescan may be needed when there is contradiction between the imaging result and clinical outcome in patients with medications affecting DAT binding.


Assuntos
Bupropiona/efeitos adversos , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/metabolismo , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Corpo Estriado/metabolismo , Glucose/metabolismo , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/tratamento farmacológico , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos/metabolismo
12.
Medicine (Baltimore) ; 98(30): e16603, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348305

RESUMO

Neuroimaging in the context of examining atypical parkinsonian tauopathies is an evolving matter. Positron emission tomography and single photon emission computed tomography (SPECT) bring tools, which may be reasonable in supplementary examination, however, cannot be interpreted as a criterion standard for correct diagnosis. The aim of this observational study was to assess the differentiating potential of perfusion SPECT in 3 types of atypical parkinsonisms: multiple system atrophy parkinsonian type (MSA-P), corticobasal syndrome (CBS), and progressive supranuclear palsy (PSP). The study was carried out using the comparison of standard deviations of perfusion in patients from these 3 groups. Data obtained from 10 patients with clinical diagnosis MSA-P, 14 patients with CBS and 21 patients with PSP, which were analyzed using Tukey honest significant difference post-hoc test, revealed significant differences of perfusion P < .05 between MSA-P and PSP within the cerebellum and thalamus. No significant differences between CBS and PSP were observed.


Assuntos
Atrofia de Múltiplos Sistemas/diagnóstico , Paralisia Supranuclear Progressiva/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Cerebelo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Tálamo/diagnóstico por imagem
13.
Nucl Med Commun ; 40(10): 1001-1004, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31343608

RESUMO

OBJECTIVES: Studies investigating the age-related impact on dopamine transporter binding have previously omitted the use of attenuation correction by computed tomography (CT). We aimed to explore the impact of age and gender on dopamine transporter binding on [I]Ioflupane single photon emission CT (SPECT) imaging with simultaneously acquired CT. METHODS: Three hundred forty-two patients with clinically uncertain parkinsonian syndrome underwent [I]-Ioflupane SPECT/CT with CT-based attenuation correction. Two nuclear medicine physicians independently performed a visual evaluation of all scans and only visibly normal scans were included for further analysis. Moreover, the results of a fully automatic semiquantitative evaluation method were recorded. Thereafter, the obtained [I]Ioflupane binding ratio and the hemispheric asymmetry index were correlated with age and sex. RESULTS: Patient age range was 41-80 years with a balanced distribution over decades. Of 342 patients, 133 (38.9%, 66 females, median age, 64 years) were considered visually normal by both observers on the SPECT/CT images. A significant inverse correlation between age and [I]Ioflupane binding ratios in the striata (R = -0.38; P < 0.001), putamina (R = -0.39; P < 0.001) and caudate nuclei (R = -0.3; P < 0.001) was demonstrated. Linear regression of all included subjects demonstrated an average decrease of 0.19 per decade in the striatal binding ratio (6.6%). No significant sex differences were found in striatal binding ratios (P = 0.86). Moreover, no significant correlation was observed between age and striatal asymmetry index (r = 0.12; P = 0.16). CONCLUSION: In the present largest single-center analysis investigating [I]Ioflupane SPECT/CT in patients with clinical uncertain parkinsonian syndrome, a dopamine transporter loss of 6.6% per decade in visually normal scans was recorded.


Assuntos
Envelhecimento/metabolismo , Nortropanos/metabolismo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Transporte Biológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/metabolismo , Estudos Retrospectivos
14.
Curr Neurol Neurosci Rep ; 19(8): 56, 2019 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-31256288

RESUMO

PURPOSE OF REVIEW: The molecular imaging field has been very instrumental in identifying the multiple network interactions that compose the human brain. The cerebral glucose metabolism is associated with neural function. 18F-fluoro-deoxyglucose-PET (FDG-PET) studies reflect brain metabolism in a pattern-specific manner. This article reviews FDG-PET studies in Parkinson's disease (PD), atypical parkinsonism (AP), Huntington's disease (HD), and dystonia. RECENT FINDINGS: The metabolic pattern of PD, disease progression, non-motor symptoms such as fatigue, depression, apathy, impulse control disorders, and cognitive impairment, and the risk of progression to dementia have been identified with FDG-PET studies. In prodromal PD, the REM sleep behavior disorder-related covariance pattern has been described. In AP, FDG-PET studies have demonstrated to be superior to D2/D3 SPECT in differentiating PD from AP. The metabolic patterns of HD and dystonia have also been described. FDG-PET studies are an excellent tool to identify patterns of brain metabolism.


Assuntos
Fluordesoxiglucose F18/metabolismo , Transtornos dos Movimentos/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Apatia , Encéfalo/metabolismo , Disfunção Cognitiva/diagnóstico por imagem , Demência/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Doença de Huntington/diagnóstico por imagem , Masculino , Doença de Parkinson/diagnóstico por imagem , Transtorno do Comportamento do Sono REM/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único
15.
Neurologist ; 24(4): 132-135, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31246722

RESUMO

The occurrence of dural arteriovenous fistula (DAVF) is rare. The clinical manifestation varies and depends on the location and venous drainage pattern. We present a case of a 57-year-old man with a left transverse sinus DAVF along with sigmoid thrombosis, cortical venous reflux, and congestion, that initially presented as parkinsonism. The patient was alert and fully oriented; however, decreased facial expressions were noted. His left forearm showed rigidity and bradykinesia, and it was difficult for the patient to smoothly perform rapid alternating movement testing. His complaints about hearing a rhythmic bruit above the left ear, particularly when lying down, alerted the physician of the presence of vascular lesions. Magnetic resonance imaging and angiography confirmed the diagnosis of DAVF. The patient received a combined surgical and endovascular approach to permanently block the fistula blood flow. The motion and movement of his left upper limb improved after fistula embolization. Images at the 1-month follow-up showed a decrease in the volume of tortuous vessels, and the fistula was completely occluded.


Assuntos
Encéfalo/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Transtornos Parkinsonianos/etiologia , Trombose dos Seios Intracranianos/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Cerebral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/diagnóstico por imagem , Seios Transversos
16.
Acta Neurol Scand ; 140(3): 229-235, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31225648

RESUMO

BACKGROUND: Neurological findings are important for the differential diagnosis of Parkinson's disease (PD), multiple system atrophy with predominant parkinsonian features (MSA-P), and progressive supranuclear palsy (PSP). There is currently no fast and reliable method to distinguish these patients. OBJECTIVES: To address this, we propose a novel approach to measure midbrain and pons size using a longitudinal "one line" method from the mid-sagittal view. METHODS: Structural images were acquired from 101 subjects who underwent 3.0 T MRI (20 controls, 44 PD, 20 MSA, 12 PSP, and 5 corticobasal syndrome). We measured the middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), midbrain, and pons. Brainstem size was measured by area or length of the longitudinal axis, which we named the "one line" method. We conducted intraclass correlation coefficients to assess the extent of agreement and consistency among raters, and receiver operating characteristic curves were used to determine diagnostic accuracy. RESULTS: Intraclass correlation coefficients (ICC) of MCP width were excellent in sagittal and axial sections while those of SCP width were moderate. There were also excellent ICCs between raters for "one line" method of the midbrain and pons, while areas showed good ICCs. "One line" method and area of the midbrain were better than SCP width for the differential diagnosis of PSP from MSA-P and PD. In contrast, there was no clearly superior measurement for differentially diagnosing MSA-P. CONCLUSIONS: The "one line" method was comparable with area for inter-rater agreement and diagnostic accuracy even though this was a simple and fast way.


Assuntos
Imagem por Ressonância Magnética/métodos , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Transtornos Parkinsonianos/diagnóstico por imagem , Paralisia Supranuclear Progressiva/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Mesencéfalo/diagnóstico por imagem , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/patologia , Transtornos Parkinsonianos/patologia , Ponte/diagnóstico por imagem , Paralisia Supranuclear Progressiva/patologia
17.
J Neurol ; 266(7): 1771-1781, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037416

RESUMO

OBJECTIVES: To provide an automated classification method for degenerative parkinsonian syndromes (PS) based on semiquantitative 123I-FP-CIT SPECT striatal indices and support-vector-machine (SVM) analysis. METHODS: 123I-FP-CIT SPECT was performed at a single-center level on 370 individuals with PS, including 280 patients with Parkinson's disease (PD), 21 with multiple system atrophy-parkinsonian type (MSA-P), 41 with progressive supranuclear palsy (PSP) and 28 with corticobasal syndrome (CBS) (mean age 70.3 years, 47% female, mean disease duration at scan 1.4 year), as well as 208 age- and gender-matched control subjects. Striatal volumes-of-interest (VOIs) uptake, VOIs asymmetry indices (AIs) and caudate/putamen (C/P) ratio were used as input for SVM individual classification using fivefold cross-validation. RESULTS: Univariate analyses showed significantly lower VOIs uptake, higher striatal AI and C/P ratio for each PS in comparison to controls (all p < 0.001). Among PS, higher degree of striatal impairment was observed in MSA-P and PSP, while CBS showed moderate uptake reduction and higher AI. Binary SVM classification showed 92.9% accuracy in distinguishing PS from controls. Classification based on each binary combination of PS ranged 62.9-83.7% accuracy with the most satisfactory results when separating CBS from the other PS. Sensitivity and specificity values were high and balanced ranging from 60 to 80% for all analyses with > 70% accuracy. Overall, striatal AI and C/P ratio on the more affected side had the highest weighting factors. CONCLUSION: Semiquantitative 123I-FP-CIT SPECT striatal evaluation combined with SVM represents a promising approach to disentangle PD from non-degenerative conditions and from atypical PS at the early stage.


Assuntos
Corpo Estriado/diagnóstico por imagem , Radioisótopos do Iodo , Transtornos Parkinsonianos/classificação , Transtornos Parkinsonianos/diagnóstico por imagem , Máquina de Vetores de Suporte , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Corpo Estriado/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Parkinsonianos/metabolismo , Estudos Retrospectivos
18.
Int J Neural Syst ; 29(9): 1950011, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31084232

RESUMO

Parkinsonism is a clinical syndrome characterized by the progressive loss of striatal dopamine. Its diagnosis is usually corroborated by neuroimaging data such as DaTSCAN neuroimages that allow visualizing the possible dopamine deficiency. During the last decade, a number of computer systems have been proposed to automatically analyze DaTSCAN neuroimages, eliminating the subjectivity inherent to the visual examination of the data. In this work, we propose a computer system based on machine learning to separate Parkinsonian patients and control subjects using the size and shape of the striatal region, modeled from DaTSCAN data. First, an algorithm based on adaptative thresholding is used to parcel the striatum. This region is then divided into two according to the brain hemisphere division and characterized with 152 measures, extracted from the volume and its three possible 2-dimensional projections. Afterwards, the Bhattacharyya distance is used to discard the least discriminative measures and, finally, the neuroimage category is estimated by means of a Support Vector Machine classifier. This method was evaluated using a dataset with 189 DaTSCAN neuroimages, obtaining an accuracy rate over 94%. This rate outperforms those obtained by previous approaches that use the intensity of each striatal voxel as a feature.


Assuntos
Corpo Estriado/patologia , Diagnóstico por Computador/métodos , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Neuroimagem Funcional , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Neuroimagem , Nortropanos/metabolismo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos
19.
AJR Am J Roentgenol ; 213(2): 243-253, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30995085

RESUMO

OBJECTIVE. The purpose of this article is to provide a review of 123I-ioflupane SPECT in the evaluation of suspected parkinsonian syndromes (PSs). This collection of diseases presents frequent diagnostic challenges, even by movement disorder and dementia specialists. CONCLUSION. The 123I-ioflupane scan serves as an imaging biomarker of the status of presynaptic dopamine transporters (DATs) in the striatum. As a result of neuronal death, DATs are greatly reduced in patients with PS neurodegenerative disorders, whereas clinical mimics generally do not show striatal DAT loss. This provides a tremendous opportunity for 123I-ioflupane to aid in the accurate and timely diagnosis of these patients and optimize their management.


Assuntos
Corpo Estriado/diagnóstico por imagem , Usos Diagnósticos de Compostos Químicos , Nortropanos , Transtornos Parkinsonianos/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Humanos , Radioisótopos do Iodo , Compostos Radiofarmacêuticos
20.
Brain Imaging Behav ; 13(6): 1733-1745, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31011950

RESUMO

The cerebellum is known to influence cerebral cortical activity via cerebello-thalamo-cortical (CTC) circuits and thereby may be implicated in the pathophysiology of multiple system atrophy (MSA). As the aim of this study, we investigated the abnormalities of corticocerebellar functional connectivity (FC) in patients with two variants of MSA. Resting-state functional magnetic resonance imaging (rs-fMRI) studies were obtained from 55 patients with MSA, including Parkinsonian (MSAp, n = 29) and cerebellar (MSAc, n = 26) variants. We also examined a similar number of healthy controls (HC, n = 51). Seed-based connectivity analysis was performed to assess alterations in CTC circuits. Relations between FC and clinical scores were assessed as well. Compared with the HC group, diminished FC was evident from bilateral dentate nucleus (DN) to motor cortex, bilateral basal ganglia, right cerebellum, default mode network (DMN), and limbic system in patients with MSAc. Patients with MSAp (vs HC subjects) showed less FC from left DN to right putamen, DMN, and limbic systems. Reduced FC was also demonstrated from left DN to DMN in patients with MSAc (vs MSAp), as well as from right DN to right cerebellum, DMN, basal ganglia, motor cortex, and limbic systems. In addition, the extent of FC from right DN to right cerebellum negatively correlated with Unified Parkinson's Disease Rating Scale-III scores in patients with MSA, while showing a positive association with Montreal Cognitive Assessment scores. The FC of DN was similarly altered in patients with MSAc and MSAp, although right cerebellar and motor cortical changes were more widespread in the MSAc group. There may be differing mechanisms of cerebellar functional activity responsible for motor and cognitive impairment, which should be further investigated.


Assuntos
Núcleos Cerebelares/fisiopatologia , Atrofia de Múltiplos Sistemas , Vias Neurais/fisiopatologia , Transtornos Parkinsonianos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Atrofia de Múltiplos Sistemas/diagnóstico por imagem , Atrofia de Múltiplos Sistemas/fisiopatologia , Transtornos Parkinsonianos/diagnóstico por imagem , Transtornos Parkinsonianos/fisiopatologia
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