Dramatic unilateral decrease in uptake via the dopamine transporter: Imaging in a patient with hemiparkinsonism following the lacunar stroke in substantia nigra

@#Vascular parkinsonism (VaP) is typically defined as having predominant lower body involvement, postural instability, less prominent rest tremor and little or no response to treatment with levodopa. In this study, we report a patient with VaP with clear demonstration of a dramatic unilateral decrease of radiotracer uptake in a 18F-FP-CIT-PET study. A 62-year-old right-handed woman was referred to the neurology department due to rest tremor and rigidity in the right hand, which began after undergoing resection surgery for a left acoustic neuroma 7 years prior. Brain MRI, taken at 1 year after surgery showed an ischemic stroke lesion in the left medial pons and the left substantia nigra. 18F-FP-CIT-PET revealed a marked reduction of radiotracer uptake in left striatum compared to that of the right. We treated the patient with 100 mg of levodopa, 200 mg of entacarpone and 25 mg of carbidopa. There was an improvement in bradykinesia and tremor, but the symptoms persisted, and there was no deterioration during 6 months of observation. After acoustic neuroma surgery, ischemic complications are uncommon, and even a small lesion in the nigrostriatal pathway can cause a hemiparkinsonism. If a patient experience sudden onset hemiparkinsonism, they should be carefully examined for lesions in the nigrostriatal pathways. Under these conditions, the 18F-FP-CIT-PET scan can enable visualization of a unilateral decrease and is a useful tool for diagnosis and differentiation from idiopathic Parkinson’s disease

Application of Diffusion Tensor Image in Diagnosis of Vascular Parkinsonism / 中国医科大学学报

Objective To study the pathogenesis of lower limb motor disorder in vascular parkinsonism(VP)using diffusion tensor image(DTI). Methods A case?control study was performed in a cohort of 16 VP patients and 32 PD patients. Patients were all recruited from the first affiliated hospital of China Medical University from Dec. 2011 to Dec. 2012. The lower limb motor function of those patients was assessed using measurement scales. All patients received magnetic resonance image(MRI)and diffusion tensor image(DTI). Results Patients in VP group showed more seri?ous movement disorders such as freezing of gait(gait ignition failure)than these in PD group,and the movement disorders of their lower limbs prog?ress more rapidly in VP group than the PD group. Movement disorders of their lower limbs in VP group were related to fibers in bilateral frontal lobes (P=0.008). Movement disorder of their lower limbs in PD group were related to fibers in substantia nigra(P=0.030). There are statistically signifi?cant differences in both the FA values of substantia nigra,bilateral frontal lobes and the ADC values of frontal lobes,and the pars compacta and pars reticulata of substantia nigra between these two groups(all P<0.05). Conclusion Movement disorders of bilateral lower limbs are more seriously manifested in VP patients than in PD patients. The onset movement dysfunction of bilateral lower limbs is closely related to fibers in the frontal lobe.

Adult-Onset Moyamoya Disease Manifesting as Vascular Parkinsonism

No abstract available.

Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes / Parkinsonismo vascular e disfunção cognitiva: revisão da literatura e estudo de casos brasileiros

Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have avascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, thethird most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading tostrategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinsons disease, dementia with Lewy bodies andother secondary causes of Parkinsonism.

Parkinsonismo vascular (VP) é a forma secundária da síndrome parkinsoniana resultante de doença cerebrovascular. Há grande variação das estimativas de frequência em estudos mundiais, sendo que em média 3% a 6% de todos os casos de parkinsonismo têm a etiologia vascular. Em um estudo brasileiro de base comunitária sobre parkinsonismo, 15,1% de todos os casos foram classificados como VP, que foi a terceira causa mais comum, com uma prevalência de 1,1% em uma coorte de idosos. Outro estudo brasileiro encontrou uma prevalência de 2,3% de VP também em idosos. VP usualmente resulta de fatores de risco vasculares como a hipertensão, levando a infartos estratégicos nos núcleos da base, lesões isquêmicas difusas da substância branca subcortical e menos comumente, infartos de grandes vasos. Os pacientes com VP geralmente são mais idosos e apresentam dificuldades para a marcha, envolvimento simétrico predominante em membros inferiores, resposta pobre à terapêutica com levodopa, instabilidade postural e quedas, comprometimento cognitivo e demência, sinais de acometimento cortico espinhal, incontinência urinária e paralisia pseudobulbar. Este artigo apresenta algumas informações práticas sobre o VP, uma condição neurológica potencialmente confundida com demência vascular, doença de Parkinson idiopática, demência com corpos de Lewy e com outras causas de parkinsonismo.

Two Cases of Palilalia

BACKGROUND: Palilalia is characterized mainly by compulsive repetitions of words and phrases, which are attenuated in loudness and increased in rate. Up to date, approximately 29 cases of palilalia secondary to various neurological insults were reported mostly as a single case study. To our knowledge, there has been no reported case of palilalia in Korea until now. In this report, we present two patients with palilalia. CASES: The first patient KH, a 52-year-old man, with vascular parkinsonism, exhibited the repetition after an episode of stroke in the bilateral basal ganglia area. The second patient SH, a 60-year-old man with idiopathic Parkinson's disease, also manifested the repetition of words and phrases. The speech performance of both patients varied with the type of speech tasks, for instance, propositional language as opposed to automatic language. COMMENT: Palilalia should be differentlly diagnosed from neurogenic stuttering, echolalia, or aphasic perseveration. A pathophysiological explanation of patient KH's palilalia would be an widespread extrapyramidal impairment that resulted in destruction of the inhibitory motor circuit which might lead to the abnormal, uncontrolled speech-related neuronal firing in the frontal lobe. On the other hand, patient SH's palilalic speech may result from hyperexcitation of downstream of dopaminergic system related to peak-dose dyskinesia.

The application of measurement of the width of pars compacta of substantia nigra in differential diagnosis on Parkinson's disease and vascular parkinsonism on MRI / 临床神经病学杂志

Objective To evaluate the value of measurement of the width of pars compacta of substantia nigra(SNc) and SNc's ratio to midbrain diameter in diagnosing Parkinson's disease(PD) and differentiating PD from vascular parkinsonism(VP) on routine MRI.Methods The width of SNc, midbrain diameter, and SNc's ratio to midbrain diameter were measured in 60 patients with PD (38 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 14 patients with Hoehn-Yahr stage Ⅲ, and 8 patients with Hoehn-Yahr stage Ⅳ), 60 patients with VP (26 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 20 patients with Hoehn-Yahr stage Ⅲ, and 14 patients with Hoehn-Yahr stage Ⅳ), and 60 age-matched heathly control subjects by means of routine axial T 2-weighted MRI. The results of measurement were analyzed and compared.Results Significant reduction was found in the width of SNc and SNc's ratio to midbrain diameter in PD compared those in VP and control subjects(P

Differential diagnosis of Parkinson disease and vascular Parkinsonism by single photon emission computed tomography imaging / 西安交通大学学报(医学版)

Objective To investigate the differential diagnosis of early-stage Parkinson disease(PD) and vascular Parkinsonism(VP) by 99Tcm-TRODAT-1 single photon emission computed tomography brain imaging.Methods 99Tcm-TRODAT-1 SPECT brain imaging was performed on 47 patients with early-stage PD,26 with early-stage VP and 30 age-matched healthy control subjects.The radioactive ratio of striatum to cerebullum was calculated by region of interest(ROI) technique.The results were analyzed and compared.Results The distribution and quantities of 99Tcm-TRODAT-1 uptake were reduced in contralateral striatum to clinically symptomatic side of the patients with early-stage PD(P0.05).The radioactive ratio of striatum to cerebullum contralateral to the affected limb in the patients with early-stage PD was lower than that in the healthy control subjects while that to patients with early-stage VP were similar to that in the healthy control subjects.Conclusion 99Tcm-TRODAT-1 single photon emission computed tomography brain imaging and semiquantitative analysis are useful to differentiate VP from PD.