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Parkinson’s Disease (PD)

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This is a 66-year-old man known

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to me on Parkinson's therapy,

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switched to another therapy upon which the

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diagnosis of a possible stroke was entertained,

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and therefore he got diffusion imaging,

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which was negative, by the way,

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did not show evidence of a stroke.

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And most likely his symptoms were related to

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tardive dyskinesia with the development of

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choreoathetosis, secondary to the new medication.

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Now, on the EPI image,

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you can see very close opposition of the

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red nuclei to the substantia nigra.

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And the substantia nigra is thickened from

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anterior to posterior due to accumulation

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of iron in the compacta region.

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Now, this is not as easily appreciated

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or not as specifically identified as it

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is in the middle image,

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which is a blood iron-sensitive sequence

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known as blood-sensitive imaging,

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BSI, SWAN, or SWI,

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susceptibility-weighted imaging.

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When we look at this image,

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we see right there that there is a paucity

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of iron in the red nucleus.

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So there's depigmentation of the red nucleus.

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The compacta stripe is very thin on one cut

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and on the next cut, the two absolutely,

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positively bleed together.

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Then in the lateral aspect of the nigra,

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maybe there's a little bit of a swallowtail here,

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but there's not much of a swallowtail on the

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patient's right side, the viewer's left.

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And the iron distributions and stores

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are completely blunted.

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Now, on the diffusion tensor image,

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attenuation of the white matter tracks posteriorly

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due to visual spatial agnosia and loss of visual

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spatial function is not specific

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to Parkinson's disease.

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It's seen in dementia with Lewy bodies,

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as well as classic Parkinson's disease,

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although some have described it as a more

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severe attenuation seen in LBD.

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So we've got three findings here, at least.

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Attenuation of the white matter tracks in the

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visual spatial pathway,

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bleeding together of the rubro nigral interface

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with loss and thinning of the compacta zone,

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and loss of iron in the outer half

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to outer third of the substantia

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nigra with loss of the normal wispy swallow

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tail in the lateral aspect of the midbrain.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Syndromes

Neuroradiology

MRI

Drug related

Brain

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