Progressive supranuclear palsy often develops idiopathic normal pressure hydrocephalus-like magnetic resonance...

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Idiopathic normal pressure hydrocephalus (iNPH) lacks definitive pathological hallmarks.
• Autopsy studies suggest iNPH patients are often misdiagnosed with progressive supranuclear palsy (PSP).
• Disproportionately enlarged subarachnoid space hydrocephalus (DESH) and periventricular white matter hyperintensities (PVHs) are characteristic iNPH MRI findings.

Purpose of the Study:

• To investigate whether PSP patients exhibit iNPH-like MRI features.
• To compare MRI findings between PSP and other neurodegenerative diseases.

Main Methods:

• Magnetic resonance imaging (MRI) was used to assess 38 PSP patients, 42 with Parkinson's disease (PD) without dementia, 30 with PD with dementia (PDD), and 29 with Alzheimer's disease (AD).
• The disproportionately enlarged subarachnoid space hydrocephalus (DESH) score and periventricular white matter hyperintensities (PVH) grade were measured.
• DESH scores and PVH grades were compared across patient groups.

Main Results:

• PSP patients showed significantly higher DESH scores compared to PD without dementia.
• PVH grades were significantly larger in PSP patients than in PD without dementia.
• PSP patients had a smaller callosal angle, a component of the DESH score, compared to PD without dementia and PDD.

Conclusions:

• Some PSP patients present with iNPH-like MRI features.
• These findings suggest iNPH-like characteristics may exist within the PSP clinical spectrum.
• A clinical phenotype of PSP with hydrocephalus is proposed for future research.