Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism
Open Access
- 12 January 2023
- journal article
- research article
- Published by Wiley in Brain and Behavior
- Vol. 13 (2), e2884
- https://doi.org/10.1002/brb3.2884
Abstract
ObjectivesThe classic triad of idiopathic normal pressure hydrocephalus (NPH) encompass gait disturbance, cognitive impairment, and urinary incontinence. These symptoms overlap with parkinsonism but with distinct treatment. Lacking applicable differentiation also hampers the prediction to therapeutic response. Here, we try to clarify this issue among different Parkinsonian syndromes and propose some innovative thinking while approaching a patient with parkinsonism and hydrocephalus concomitantly. MethodsTwenty-four patients with clinical probable multiple system atrophy (MSA), 34 with probable progressive supranuclear palsy (PSP), and 58 with sex- and age-matched Parkinson's disease (PD) were enrolled. Evans' index (EI), callosal angle (CA), antero-posterior (AP) diameter of the midbrain, length of the midbrain tegmentum diameter (MBTegm), and disproportionately enlarged subarachnoid space hydrocephalus (DESH) were evaluated using the conventional MRI. Logistic regression was applied to identify the independent variables in hydrocephalus. ResultsPatients with PSP had higher mean EI than those with MSA and PD. Around 38.2% of patients with PSP had accompanied hydrocephalus (EI > 0.3). Parkinsonism subtypes (PD, MSA, or PSP), AP diameter of the midbrain, and MBTegm were significantly different among patients with and without hydrocephalus. After regression analysis, parkinsonism subtype stood out to be the most key risk factor of hydrocephalus. The comparison between patients with PSP with and without hydrocephalus did not disclose specific clinical characteristics or risk factors. ConclusionsThis study demonstrates that the presence of NPH-like MRI features is much higher in PSP patients, and this tendency is decided upon the determination of parkinsonism subtype. Sharing pathophysiological characteristics in these two diseases is implied. More diagnostic tools are needed to better differentiate the two diseases and decide the treatment. To closely observe hydrocephalic parkinsonism patients and well inform the possible limited shunting benefits if PSP core features appear, will be more pivotal and practical at present clinical practice.Keywords
Funding Information
- Chang Gung Medical Foundation (CMRPG8H0801, CMRPG8J1361)
This publication has 45 references indexed in Scilit:
- Incidence of Idiopathic Normal-Pressure Hydrocephalus in Northern SpainWorld Neurosurgery, 2016
- Multiple-System AtrophyThe New England Journal of Medicine, 2015
- Utility of the Midbrain Tegmentum Diameter in the Differential Diagnosis of Progressive Supranuclear Palsy from Idiopathic Parkinson's DiseaseJournal of Clinical Neurology, 2015
- Hydrocephalic Parkinsonism: lessons from normal pressure hydrocephalus mimicsJournal of Clinical Movement Disorders, 2014
- Normal pressure hydrocephalus or progressive supranuclear palsy? A clinicopathological case seriesZeitschrift für Neurologie, 2012
- Second consensus statement on the diagnosis of multiple system atrophyNeurology, 2008
- Measurement of the Midbrain Diameter on Routine Magnetic Resonance ImagingArchives of Neurology, 2001
- Progressive supranuclear palsy and normal‐pressure hydrocephalusNeurology, 1979
- The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: Observations on cerebrospinal fluid hydrodynamicsJournal of the Neurological Sciences, 1965
- Symptomatic Occult Hydrocephalus with Normal Cerebrospinal-Fluid PressureThe New England Journal of Medicine, 1965