Parkinson's disease

 

Still diagnostic dilemma, with up to 25% misdiagnosis in UK neurologists of atypical PD (Parkinson's plus syndromes).

 

MSA-P = parkinson's type

MSA-C = cerebellar type

 

Orofacial dystonia with L-dopa is suspect for MSA.

Lymphocytic infiltrate in muscle causing neck weakness and trunk erector muscle can be seen in MSA.

 

Diagnostic tests:

- drug challenge - L-dopa, apomorphone

- olfactory testing - PSP

- EMG studies

- autonomic fcn

- imaging

- genetic testing

 

Imaging studies:

- PET - 18-F-dopa, raclopride, FDG

- SPECT

- MRI - MRS, DWI

- transcranial U/S

 

Putaminal atrophy, putaminal slot sign, hypointensity seen in MSA. Atrophy of pons, etc. But limited sensitivity.

 

DWI - decreased restriction in putamen in MSA and PSP.

 

SPECT - D2 receptor imaging - reduced in MSA and PSP