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Background: Multiple system atrophy (MSA) is a rapidly progressive neurodegenerative disorder that has no curative treatment. Diagnosis is based on a set of criteria established by Gilman (1998 and 2008) and recently updated by Wenning (2022). We aim to determine the effectiveness of [123I]Ioflupane SPECT in MSA, especially at the initial clinical suspicion. Methods: A cross-sectional study of patients at the initial clinical suspicion of MSA, referred for [123I]Ioflupane SPECT. Results: Overall, 139 patients (68 men, 71 women) were included, 104 being MSA-probable and 35 MSA-possible. MRI was normal in 89.2%, while SPECT was positive in 78.45%. SPECT showed high sensitivity (82.46%) and positive predictive value (86.24), reaching maximum sensitivity in MSA-P (97.26%). Significant differences were found when relating both SPECT assessments in the healthy–sick and inconclusive–sick groups. We also found an association when relating SPECT to the subtype (MSA-C or MSA-P), as well as to the presence of parkinsonian symptoms. Lateralization of striatal involvement was detected (left side). Conclusions: [123I]Ioflupane SPECT is a useful and reliable tool for diagnosing MSA, with good effectiveness and accuracy. Qualitative assessment shows a clear superiority when distinguishing between the healthy–sick categories, as well as between the parkinsonian (MSA-P) and cerebellar (MSA-C) subtypes at initial clinical suspicion.

Resumen Fundamento y objetivo Evaluar el estado funcional de la via nigro-estriada utilizando N-ω-fluoropropil-2s-carbometoxi-3s-(4-Iodofenil) nortropano (FP-CIT-I-123) en pacientes con diagnostico clinico de atrofia multisistemica (AMS) subtipo C. Pacientes y metodo Se incluyen 10 pacientes con diagnostico clinico de AMS-C y se comparan con 10 diagnosticados de temblor esencial (controles) y otros 10 con enfermedad de Parkinson (EP). Los estudios son valorados mediante el indice estriado/occipital (E/O), calculando la validez diagnostica del procedimiento mediante curvas ROC. Resultados El valor medio (DE) del indice E/O fue de 1,48 (0,23), 1,59 (0,17) y 1,22 (0,16), correspondientes, respectivamente, a AMS-C, controles (p = 0,25) y EP (p = 0,00). Curva ROC: Az: 0,650; sensibilidad: 0,50; especificidad: 0,80. La correlacion del estudio con FP-CIT y la clinica predominante mostro 4 pacientes con clinica parkinsoniana y estudio patologico, 4 sin clinica parkinsoniana y estudio normal, uno con clinica parkinsoniana y estudio normal, y uno sin clinica parkinsoniana y estudio patologico. Conclusiones El estudio con FP-CIT no permite descartar totalmente la existencia de una AMS-C. Desde el punto de vista funcional, no siempre parece existir congruencia entre el estado de la via nigro-estriada y la existencia de parkinsonismo.

Hemiplegic migraine (HM) is an unusual type of migraine, with few cases reported in the literature. Unlike other types of migraine, aura HM presents accompanying motor deficit manifestations that do not last more than 24 hours. We report a 27-year-old man referred to us from the emergency department to carry out a cerebral perfusion SPECT with (99m)Tc-HMPAO. He presented with intense headache and motor weakness. The brain perfusion scan was performed before and after intravenous infusion with nimodipine and showed a significant change of cerebral blood flow, allowing early and correct diagnosis.