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Parkinsonian Syndromes
Akiva Mintz, MD, PhD, MHA, CFA; Jongho Kim, MD, PhD, FACNM
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Definitions

          • Parkinsonian syndrome (PS)
            • Clinical syndrome presenting with any combination of bradykinesia, resting tremor, rigidity, and postural instability
          • Parkinson disease (PD)
            • Chronic progressive disorder caused by degenerative loss of dopaminergic neurons
            • Characterized by asymmetry and benefits from dopaminergic therapy
          • Atypical parkinsonian syndrome (APS)
            • Characterized by more rapid progression and poorer prognosis than PD
            • Includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD)
          • Dementia with Lewy bodies (DLB)
            • Dementia plus visual hallucinations, parkinsonism, cognitive fluctuations, dysautonomia, sleep disorders, and neuroleptic sensitivity
          • Drug-induced parkinsonism (DIP)
            • Secondary parkinsonism, usually reversible
          • Vascular parkinsonism (VP)
            • Small vessel disease, multiple lacunar infarcts in basal ganglia
          • Essential tremor (ET)
            • Most common cause of action tremor in adults
            • Slow, gradual progression

        IMAGING

        • General Features

          • Imaging Recommendations

            • Artifacts and Quality Control

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      DIAGNOSTIC CHECKLIST

                      • Image Interpretation Pearls

                        • Reporting Tips

                          Selected References

                          1. Broski SM et al: Structural and functional imaging in parkinsonian syndromes. Radiographics. 34(5):1273-92, 2014
                          2. Bajaj N et al: Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry. 84(11):1288-95, 2013
                          3. Djang DS et al: SNM practice guideline for dopamine transporter imaging with 123I-ioflupane SPECT 1.0. J Nucl Med. 53(1):154-63, 2012
                          4. Tang CC et al: Differential diagnosis of parkinsonism: a metabolic imaging study using pattern analysis. Lancet Neurol. 9(2):149-58, 2010
                          5. Booij J et al: Dopamine transporter imaging with [(123)I]FP-CIT SPECT: potential effects of drugs. Eur J Nucl Med Mol Imaging. 35(2):424-38, 2008
                          6. Ibrahim N et al: The sensitivity and specificity of F-DOPA PET in a movement disorder clinic. Am J Nucl Med Mol Imaging. 6(1):102-9, 2016
                          7. Eshuis SA et al: Comparison of FP-CIT SPECT with F-DOPA PET in patients with de novo and advanced Parkinson's disease. Eur J Nucl Med Mol Imaging. 33(2):200-9, 2006
                          8. Dhawan V et al: Comparative analysis of striatal FDOPA uptake in Parkinson's disease: ratio method versus graphical approach. J Nucl Med. 43(10):1324-30, 2002
                          9. Brooks DJ: Imaging approaches to Parkinson disease. J Nucl Med. 51(4):596-609, 2010
                          10. Eckert T et al: FDG PET in the differential diagnosis of parkinsonian disorders. Neuroimage. 26(3):912-21, 2005
                          11. Marek K et al: [123I.] Neurology. 57(11):2089-94, 2001
                          12. FDA prescribing information for DaTscan Website. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022454sOrig1s000Lbl.pdf
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              • Top Differential Diagnoses

                                TERMINOLOGY

                                • Definitions

                                  • Parkinsonian syndrome (PS)
                                    • Clinical syndrome presenting with any combination of bradykinesia, resting tremor, rigidity, and postural instability
                                  • Parkinson disease (PD)
                                    • Chronic progressive disorder caused by degenerative loss of dopaminergic neurons
                                    • Characterized by asymmetry and benefits from dopaminergic therapy
                                  • Atypical parkinsonian syndrome (APS)
                                    • Characterized by more rapid progression and poorer prognosis than PD
                                    • Includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD)
                                  • Dementia with Lewy bodies (DLB)
                                    • Dementia plus visual hallucinations, parkinsonism, cognitive fluctuations, dysautonomia, sleep disorders, and neuroleptic sensitivity
                                  • Drug-induced parkinsonism (DIP)
                                    • Secondary parkinsonism, usually reversible
                                  • Vascular parkinsonism (VP)
                                    • Small vessel disease, multiple lacunar infarcts in basal ganglia
                                  • Essential tremor (ET)
                                    • Most common cause of action tremor in adults
                                    • Slow, gradual progression

                                IMAGING

                                • General Features

                                  • Imaging Recommendations

                                    • Artifacts and Quality Control

                                      DIFFERENTIAL DIAGNOSIS

                                        PATHOLOGY

                                        • General Features

                                          CLINICAL ISSUES

                                          • Presentation

                                            • Demographics

                                              DIAGNOSTIC CHECKLIST

                                              • Image Interpretation Pearls

                                                • Reporting Tips

                                                  Selected References

                                                  1. Broski SM et al: Structural and functional imaging in parkinsonian syndromes. Radiographics. 34(5):1273-92, 2014
                                                  2. Bajaj N et al: Clinical utility of dopamine transporter single photon emission CT (DaT-SPECT) with (123I) ioflupane in diagnosis of parkinsonian syndromes. J Neurol Neurosurg Psychiatry. 84(11):1288-95, 2013
                                                  3. Djang DS et al: SNM practice guideline for dopamine transporter imaging with 123I-ioflupane SPECT 1.0. J Nucl Med. 53(1):154-63, 2012
                                                  4. Tang CC et al: Differential diagnosis of parkinsonism: a metabolic imaging study using pattern analysis. Lancet Neurol. 9(2):149-58, 2010
                                                  5. Booij J et al: Dopamine transporter imaging with [(123)I]FP-CIT SPECT: potential effects of drugs. Eur J Nucl Med Mol Imaging. 35(2):424-38, 2008
                                                  6. Ibrahim N et al: The sensitivity and specificity of F-DOPA PET in a movement disorder clinic. Am J Nucl Med Mol Imaging. 6(1):102-9, 2016
                                                  7. Eshuis SA et al: Comparison of FP-CIT SPECT with F-DOPA PET in patients with de novo and advanced Parkinson's disease. Eur J Nucl Med Mol Imaging. 33(2):200-9, 2006
                                                  8. Dhawan V et al: Comparative analysis of striatal FDOPA uptake in Parkinson's disease: ratio method versus graphical approach. J Nucl Med. 43(10):1324-30, 2002
                                                  9. Brooks DJ: Imaging approaches to Parkinson disease. J Nucl Med. 51(4):596-609, 2010
                                                  10. Eckert T et al: FDG PET in the differential diagnosis of parkinsonian disorders. Neuroimage. 26(3):912-21, 2005
                                                  11. Marek K et al: [123I.] Neurology. 57(11):2089-94, 2001
                                                  12. FDA prescribing information for DaTscan Website. http://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022454sOrig1s000Lbl.pdf