Vascular Parkinsonism by Infarctions at Different Locations on 18F-FP-CIT PET/CT

Extrastriatal Accumulation of 18F-FP-CIT at Cerebral Infarction in a Patient With Suspected Parkinson Disease

ABSTRACT

18F-FP-CIT PET/CT is a useful diagnostic tool for differentiating between idiopathic Parkinson disease and atypical Parkinson syndrome by visualizing the striatum, where the nerve endings of nigrostriatal dopaminergic neurons are located. We present an unusual accumulation of 18F-FP-CIT in the infarct and peri-infarct brain area of an 83-year-old man who was referred for the management of suspected cerebral infarction due to sudden dysarthria and delirium.

Cerebral Infarction With Increased Uptake on 123I-FP-CIT SPECT

ABSTRACT

A 76-year-old woman underwent 123I-FP-CIT brain SPECT due to postural reflex impairment. The transverse slices demonstrated increased uptake in the right middle cerebral artery territory. MR images obtained 2 weeks earlier showed cerebral infarction in the corresponding area. 123I-FP-CIT has high binding affinity for dopamine transporters, especially in the nerve endings of nigrostriatal dopaminergic neurons.

FUNCTIONAL NEUROMARKERS IN PARKINSON’S DISEASE (PD)

New neurotechnologies which help to study not only the structure but also brain work, especially in milliseconds, allow for a more accurate diagnosis of a given disease entity. The aim of our study was to characterize the functional neuromarkers, including a new neuromarker, that is high rolandic beta, in Parkinson’s disease (PD). A 76-year-old male patient, a university professor, a widower, in an intimate relationship with a beloved partner, was tested in the Reintegration and Training Center of the Polish Society of Neuropsychology. Five years earlier (when he was 71 years old), following long-term stress, he had had a transient ischemic attack (TIA). In the following years he experienced two neurological episodes, and was diagnosed, on the basis of MRI findings and clinical symptoms, with vascular (multi-infarct) Parkinsonism. A sudden deterioration in his functioning, including hand tremors at rest, bradykinesia (motor slowdown), asymmetrical gait difficulties, postural instability, and falls typical for PD, as well as MRI finding (the appearance of ‘a swallow tail ’ on the left side, and the lack on the right of the substantia nigra within the midbrain) was the cause of further differential diagnosis. He was assessed using the HBI methodology (Kropotov 2016; Pąchalska, Kaczmarek, Kropotov 2014). EEG was recorded from 19 scalp sites, in resting state conditions, with eyes open and eyes closed, and during the cued GO/NOGO tasks with animal/plants as GO/NOGO stimuli. The electrodes were applied according to the International 10-20 system. The EEG was recorded referentially to linked ears, allowing for a computational re-referencing of the data (remontaging). Event related potentials (ERPs) were used to assess the functional changes manifested by the patient. To compare our patient with healthy controls we used the normative Human Brain Index (HBI), a database obtained through joint research by Swiss, Norwegian, Polish and Russian neuroscientists (Kropotov 2018). This database included behavioral parameters and ERP measures in 6 different neuropsychological tasks for 1000 healthy subjects. What is striking, no signs of cognitive dysfunction was found; however observed were an asymmetrical frontal lobe alpha (a neuromarker of depression) and excessive Rolandic beta (a neuromarker of Parkinson’s disease). We will discuss the results on the basis of recent subject literature findings, including the personal factors that might influenced the process of the diagnosis and treatment of this patient, ones which should be also taken into account in any differential diagnosis. The obtained results show the importance of using HBI methodology in clinical practice. Physicians involved in the diagnosis and treatment of those with progressive ambulatory impairment and an abnormal white matter (WM) signal on neuroimaging, should when formulating any differential diagnosis consider the use of this approach. ------------------------------------------------------------------------------------------------------------------------------------

Neuroimaging in Vascular Parkinsonism

PURPOSE OF REVIEW

Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP.

RECENT FINDINGS

Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.