Transcranial color-coded sonography helps differentiation between idiopathic Parkinson's disease and vascular parkinsonism
Journal
Journal of Neurology
Journal Volume
254
Journal Issue
4
Pages
501-507
Date Issued
2007
Author(s)
Abstract
Background: Recently, transcranial color-coded sonography (TCCS) has been found to have a diagnostic value in patients with idiopathic Parkinson's disease (IPD), which displays increased hyperechogenicity at the substantia nigra (SN). Objective: To use TCCS, to assess the difference in SN hyperechogenicity and intracranial hemodynamics among subjects with IPD, vascular parkinsonism (VP) and controls. Methods: Eighty IPD and 30 VP patients, and 60 controls were recruited into this study. The hyperechogenicity area at the SN and midbrain were calculated by encircling the outer circumference from the ipsilateral temporal window, using TCCS in each subject. The hemodynamics of intracranial large arteries, including flow velocity and pulsatility index (PI), were also measured. Results: The presence of SN hyperechogenicity was significantly higher in the IPD patients than in the VP patients and controls (84% vs. 20% & 5%, respectively, p < 0.001). In IPD patients, the SN hyperechogenicity was correlated with the neurological severity and disease duration. Twenty-five (66.7%) VP patients had obvious vascular abnormality, as seen in TCCS study. The mean PI was significantly more elevated in the VP patients than those in the IPD patients and controls (all p < 0.05), but there was no significant difference of flow velocities among the VP, IPD patients and controls. Conclusions: TCCS, combining B-mode imaging for SN echogenicity and trancranial Doppler for intracranial hemodynamics, is a useful diagnostic tool in the differentiation between IPD and VP. These findings also suggest that multiple subcortical vascular lesions may damage the basal ganglia and thalamocortical circuit and result in parkinsonism features in VP patients. ? 2007 Steinkopff-Verlag.
SDGs
Other Subjects
adult; aged; article; brain artery; controlled study; diagnostic value; differential diagnosis; disease duration; disease severity; Doppler echography; female; flow rate; hemodynamics; human; major clinical study; male; Parkinson disease; parkinsonism; priority journal; substantia nigra; Aged; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Parkinson Disease; Parkinson Disease, Secondary; Retrospective Studies; Severity of Illness Index; Statistics, Nonparametric; Substantia Nigra; Ultrasonography, Doppler, Transcranial
Type
journal article