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Clinical and magnetic resonance imaging study of extrapyramidal symptoms in multiple system atrophy
M Konagaya1, Y Konagaya, M Iida
1Department of Neurology, Suzuka National Hospital, Japan.
Abstract:
Slit-hyperintensity in the outer margin of the putamen on T2 weighted MRI was found in 17 out of 28 patients with clinically diagnosed multiple system atrophy. Thirteen of these 17 patients showed extrapyramidal signs. Five patients had only unilateral slit-hyperintensity; four of them had contralateral rigidity; and one had bradykinesia. Despite mild rigidity, one case showed no slit-hyperintensity. One of the 14 cases with parkinsonism showed no hyperintensity, and four of the 14 cases without parkinsonism showed hyperintensity. On the other hand, slit-hyperintensity was not seen in any of 25 patients with clinically diagnosed Parkinson's disease. Putaminal slit-hyperintensity is a useful MRI feature in the differential diagnosis between Parkinson's disease and multiple system atrophy predominantly affecting the extrapyramidal system.
Insights
Putaminal slit-hyperintensity on MRI is a key indicator for differentiating multiple system atrophy from Parkinson's disease. This MRI finding aids in diagnosing neurological disorders affecting motor control.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Multiple system atrophy (MSA) and Parkinson's disease (PD) are neurodegenerative disorders that can present with overlapping motor symptoms.
- Accurate differential diagnosis is crucial for appropriate patient management and treatment strategies.
Purpose of the Study:
- To investigate the diagnostic utility of putaminal slit-hyperintensity on T2-weighted MRI in distinguishing MSA from PD.
- To correlate the presence and characteristics of slit-hyperintensity with clinical features in MSA patients.
Main Methods:
- Retrospective analysis of T2-weighted MRI scans from patients with clinically diagnosed MSA and PD.
- Clinical data, including the presence of extrapyramidal signs and parkinsonism, were reviewed.
- Statistical analysis to determine the association between MRI findings and specific diagnoses.
Main Results:
- Slit-hyperintensity in the outer putamen was observed in 17 of 28 MSA patients, often associated with extrapyramidal signs.
- Unilateral hyperintensity correlated with contralateral motor symptoms in some MSA cases.
- No slit-hyperintensity was detected in 25 patients diagnosed with Parkinson's disease, distinguishing it from MSA.
Conclusions:
- Putaminal slit-hyperintensity on T2-weighted MRI is a valuable imaging biomarker for differentiating multiple system atrophy from Parkinson's disease.
- This MRI feature can aid neurologists in the differential diagnosis of parkinsonian syndromes, particularly when extrapyramidal signs are present.