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Imaging counterpart of postural instability and vertical ocular dysfunction in patients with PSP: A multimodal MRI study.
- Source :
-
Parkinsonism & related disorders [Parkinsonism Relat Disord] 2019 Jun; Vol. 63, pp. 124-130. Date of Electronic Publication: 2019 Feb 19. - Publication Year :
- 2019
-
Abstract
- Introduction: We investigated the imaging counterpart of two functional domains (ocular motor dysfunction and postural instability) in progressive supranuclear palsy (PSP) patients classified according to the new clinical diagnostic criteria.<br />Methods: Forty-eight patients with probable PSP-Richardson's syndrome (PSP-RS), 30 with probable PSP-parkinsonism (PSP-P), 37 with Parkinson's disease (PD), and 38 controls were enrolled. For each functional domain, PSP patients were stratified by two certainty levels: vertical supranuclear gaze palsy (O1) and slowness of vertical saccades (O2) for ocular motor dysfunction; early unprovoked falls and tendency to fall on the pull-test for postural instability. Voxel-based morphometry (VBM), whole-brain fractional anisotropy (FA) and MR planimetric measurements were analysed and compared across patient groups.<br />Results: O1 was present in 64%, and O2 in 36% of all PSP patients. All PSP-RS patients showed early unprovoked falls. TBSS whole-brain analysis revealed that superior cerebellar peduncles (SCPs) were the only structures with significantly lower FA values in PSP-RS compared with PSP-P patients. PSP/O1 patients had lower FA values in midbrain than PSP/O2 patients. By contrast, VBM revealed no differences in grey matter volume between PSP patient groups. MR Planimetric measurements confirmed atrophy of midbrain and SCPs, in line with DTI findings.<br />Conclusions: Our study demonstrates that SCPs were significantly more damaged in patients with PSP-RS in comparison with PSP-P patients, thus suggesting the role of SCPs in developing postural instability. Midbrain damage was less severe in O2 than in O1 patients, suggesting that the degree of vertical ocular dysfunction reflects the severity of midbrain atrophy.<br /> (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Subjects :
- Aged
Atrophy diagnostic imaging
Atrophy pathology
Cerebellum pathology
Female
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging methods
Male
Mesencephalon pathology
Middle Aged
Multimodal Imaging methods
Postural Balance physiology
Sensation Disorders etiology
Sensation Disorders pathology
Supranuclear Palsy, Progressive complications
Supranuclear Palsy, Progressive pathology
Cerebellum diagnostic imaging
Mesencephalon diagnostic imaging
Sensation Disorders diagnostic imaging
Supranuclear Palsy, Progressive diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1873-5126
- Volume :
- 63
- Database :
- MEDLINE
- Journal :
- Parkinsonism & related disorders
- Publication Type :
- Academic Journal
- Accession number :
- 30803901
- Full Text :
- https://doi.org/10.1016/j.parkreldis.2019.02.022