Midbrain Atrophy in Vascular Parkinsonism

Abstract

Background: Midbrain atrophy is a well-known feature of progressive supranuclear palsy (PSP). Some clinical features of vascular parkinsonism (VP) such as pseudobulbar phenomena, lower body predominance and early postural instability suggest that the brainstem could be associated with VP. The aim of this study was to determine whether midbrain atrophy was present in patients with VP. Methods: We measured the midbrain (Amd) and pons area (Apn) of 20 patients with VP, 15 patients with probable PSP and 30 patients with idiopathic Parkinson’s disease (IPD). The Amd and Apn were measured on mid-sagittal T₁-weighted MRI scans using a computerized image analysis system. Results: For the Amd, the patients with VP (99.86 mm²) and PSP (87.30 mm²) had significantly smaller areas than the patients with IPD (130.52 mm²). For the Apn, there was a significant difference only between the VP (407.23 mm²) and the IPD (445.05 mm²) patients. The Amd/Apn ratios of the patients with VP (0.245) and PSP (0.208) were significantly smaller than in the patients with IPD (0.292). Conclusions: Our study shows that brainstem atrophy often occurs in patients with VP and the midbrain is more vulnerable than the pons to atrophic changes.

Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be?

“…Quantitative measures of midbrain anterior‐posterior diameter and midsagittal area or volume have also been assessed. Studies are in general agreement that midbrain measurements are smaller in PSP‐RS compared with MSA and PD, although overlap can occur at the individual level, particularly between PSP‐RS and MSA . Diagnostic sensitivity and specificity values (Table ) are typically high (>90%) for differentiating PSP‐RS from controls and from MSA and PD using midbrain area, although midbrain diameter and volume and visual assessments have been more variable, not always meeting the 80% cut point required for a level 2 biomarker.…”

Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy

“…19 On the same plane of the pontine distance we also measured the prepontine distance and obtained the pre-pontine/pontine ratio (Figure 1(a)). However, since the pontine tegmentum and the collicular plate were not included in these measures (to maximize the chance of detecting atrophy of these regions), we decided to calculate also the maximum midsagittal antero-posterior (AP) diameters of the pons and midbrain as previously described 20 (see supplemental material, e- Figure 1). …”

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“…In contrast, measurements of midbrain size showed good inter-rater agreement and AUC in the present study, while previous studies had varied results. 5,10,15,18,21,22,30 Although morphometric analysis was useful, a multimodal approach could provide improved diagnostic power. A previous study reported that apparent diffusion coefficient (ADC) values, calculated using diffusion-weighted images, were increased in the MCP and pons of patients with MSA.…”