ABSTRACT
INTRODUCTION: Blepharospasm is a focal dystonia characterized by involuntary cocontraction of the eyelid protractors, causing spasmodic closure of the eyelids. Apraxia of eyelid opening is caused by an inability to initiate lid opening without paralytic abnormality. Some studies suggest that patients with either pure blepharospasm or blepharospasm associated with apraxia of eyelid opening are more prone to developing Parkinson's disease. METHODS: In our study, 123I-FP-CIT (DAT) SPECT was performed in 24 patients with either pure blepharospasm or blepharospasm associated with apraxia of eyelid opening and no signs of parkinsonism to identify dopaminergic dysfunction. RESULTS: DAT-SPECT was abnormal in 11 (46%) cases (five patients with isolated blepharospasm and six patients with blepharospasm associated with apraxia of eyelid opening) whose mean disease duration was 11 years. CONCLUSION: Our study revealed presynaptic dopaminergic dysfunction, as determined by 123I-FP-CIT or DAT-SPECT, in nearly half of our blepharospasm patients (with or without apraxia of eyelid opening). Thus, the presence of blepharospasm might be an early sign of a parkinsonian syndrome.
Subject(s)
Blepharospasm/diagnosis , Parkinson Disease/diagnosis , Tomography, Emission-Computed, Single-Photon/methods , Tropanes , Aged , Apraxias/complications , Apraxias/diagnosis , Blepharospasm/complications , Early Diagnosis , Eyelids/diagnostic imaging , Female , Humans , Male , Middle Aged , Parkinsonian Disorders/diagnosis , Predictive Value of Tests , Prodromal Symptoms , Tropanes/chemistryABSTRACT
BACKGROUND AND PURPOSE: Essential tremor is an abnormal movement characterized by postural and/or kinetic tremor. In some essential tremor patients, rest tremor (RT) is observed but it is not clear if this RT is a feature of essential tremor or a symptom of Parkinson's disease (PD). I123-FP-CIT single-photon emission tomography is used to distinguish essential tremor and PD. OBJECTIVES: To analyse I123-FP-CIT single-photon emission tomography in a larger series of patients with mixed tremor (i.e. action tremor associated with RT) without PD criteria. METHODS: We studied 33 consecutives patients (18 men and 15 women) with mixed tremor, clinically and by neuroimaging in all cases. RESULTS: I123-FP-CIT single-photon emission tomography was abnormal in 25 of our patients (75.7%) with mixed tremor, and we noted a reduced uptake mostly in the putamen. In our patients with abnormal imaging, RT was unilateral in 52%. In 15 of these 25 patients, putaminal reduced uptake was bilateral and symmetrical. In the other 10 patients, putaminal reduced uptake was asymmetrical or unilateral. In these 10 cases, six had a unilateral RT corresponding to (crossed) predominant reduced uptake in three cases. In our patients with normal imaging, RT was unilateral in 87.5%. CONCLUSIONS: This study shows that mixed tremor is a heterogeneous entity. The majority of patients with mixed tremor showed nigrostriatal dysfunction on I123-FP-CIT single-photon emission tomography, suggesting that mixed tremor may be a parkinsonian syndrome rather than a clinical variant of essential tremor.
Subject(s)
Dopamine Plasma Membrane Transport Proteins/metabolism , Essential Tremor/diagnosis , Putamen/metabolism , Tomography, Emission-Computed, Single-Photon , Tremor/diagnosis , Tropanes , Aged , Essential Tremor/diagnostic imaging , Essential Tremor/metabolism , Female , Functional Laterality , Functional Neuroimaging , Humans , Iodine Radioisotopes , Male , Putamen/diagnostic imaging , Severity of Illness Index , Tremor/diagnostic imaging , Tremor/metabolismABSTRACT
There is evidence for the interest of (18)F-fluoro-deoxyglucose positron emission tomography with computed tomography ((18)F-FDG-PET/CT) in fever of unknown origin (FUO) clinical investigation. However, little and conflicting data exist about its place in the investigation procedure. The aim of this work was to evaluate the clinical value of (18)F-FDG-PET/CT in patients with FUO and identify patients who need early (18)F-FDG-PET/CT rather than a last-resort procedure. We performed a 2-year retrospective cohort study at the Nîmes University Hospital, France. A total of 79 patients (36 men, 43 women, mean age 54.0 ± 16.2 years) with FUO underwent (18)F-FDG-PET/CT. A final diagnosis was established in 61 (77.2 %) cases. Aetiologies of FUO were determined using (18)F-FDG-PET/CT findings in 45 (73.8 % of patients with diagnosis) cases. The sensibility and specificity value were 98 % and 87 %, respectively. The presence of adenopathy, low haemoglobin and increased C-reactive protein (CRP) were predictors of high-yield (18)F-FDG-PET/CT. (18)F-FDG-PET/CT may help to detect most causes of FUO. The predictors of high-yield (18)F-FDG-PET/CT found in this study can help identify patients likely to benefit from specific and early imaging techniques.
Subject(s)
Fever of Unknown Origin/diagnosis , Fluorodeoxyglucose F18 , Multimodal Imaging/methods , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Algorithms , Female , France , Humans , Male , Middle Aged , Retrospective Studies , Sensitivity and SpecificitySubject(s)
Cerebellum/physiopathology , Cerebral Cortex/physiopathology , Infarction, Anterior Cerebral Artery/physiopathology , Cerebellum/metabolism , Cerebral Cortex/metabolism , Cognition Disorders/diagnosis , Cognition Disorders/physiopathology , Diffusion Tensor Imaging , Humans , Infarction, Anterior Cerebral Artery/complications , Male , Middle Aged , Neuropsychological Tests , Positron-Emission TomographySubject(s)
Cerebral Cortex , Fluorodeoxyglucose F18 , Hippocampus/pathology , Magnetic Resonance Imaging , Positron-Emission Tomography , Cerebral Cortex/abnormalities , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/pathology , Female , Hippocampus/diagnostic imaging , Humans , Seizures/complications , Seizures/pathology , Young AdultABSTRACT
Camptocormia is characterised as an extreme bent-forward posture of the trunk that disappears in the recumbent position. On X-ray, trunk flexion appears without vertebral rotation as in scoliosis. The condition is a well-known complication of Parkinson's disease (PD) at the late stage. The authors present the case of a 77-year-old woman affected by severe camptocormia, which appeared and worsened in less than 6 months and hindered gait. Despite no signs of PD, neuro-imaging (DAT-Scan) showed an L-Dopa transducer decrease in putamens. A few weeks later, bradykinesia appeared and the clinical diagnosis of PD became more obvious. L-Dopa improved bradykinesia but did not change the bent-spine posture. A 1-year follow-up showed no other signs of PD other than bradykinesia, but the camptocormia was unchanged.
