Transcranial sonography in movement disorders

Berg, Daniela; Godau, Jana; Walter, Uwe

doi:10.1016/s1474-4422(08)70239-4

Cited by 339 publications

(439 citation statements)

References 96 publications

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“…4 In another study, a reduction of the echogenic area was found in patients with restless legs syndrome. 5 To our knowledge, the echogenicity of the substantia nigra has previously not been investigated in patients with ADHD.…”

Section: Introductionmentioning

confidence: 97%

“…Because the structure of the substantia nigra is easily accessible by transcranial sonography (TCS), assessment of the substantia nigra by TCS may reveal important insights into the function of the dopaminergic system without ionizing radiation. 4,5 Indeed, 2 prototypical neurologic disorders associated with dysfunction of dopaminergic neurotransmission have revealed abnormalities of the echogenic substantia nigra. In one study, the echogenic area of the substantia nigra was enlarged in a large proportion of patients with idiopathic Parkinson disease.…”

Section: Introductionmentioning

confidence: 99%

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Structural abnormality of the substantia nigra in children with attention-deficit hyperactivity disorder

Romanos

Weise

Schliesser

et al. 2010

jpn

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55Background: Structural abnormality of the substantia nigra can be detected by transcranial sonography in neuropsychiatric disorders such as Parkinson disease and restless legs syndrome. We investigated echogenicity of the substantia nigra as a potential structural marker for dysfunction of the nigrostriatal dopamine system in children with attention-deficit hyperactivity disorder (ADHD). Methods: We used a blinded design and determined echogenicity of the substantia nigra by use of transcranial sonography in 22 children with ADHD and 22 healthy controls matched for age and sex. Results: The echogenic substantia nigra area was significantly larger in ADHD patients than in healthy controls (F 1,42 = 9.298, p = 0.004, effect size = 0.92). We found no effects of age or sex. Limitations: Owing to a lack of dimensional assessment, we could not analyze the correlation between echogenicity and clinical symptoms. Conclusion: Our results support the hypothesis that the nigrostriatal dopaminergic system is abnormal in children with ADHD.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Structural abnormality of the substantia nigra in children with attention-deficit hyperactivity disorder

Romanos

Weise

Schliesser

et al. 2010

jpn

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“…SNH is less frequently encountered in essential tremor, vascular parkinsonism, multiple system atrophy and progressive supranuclear palsy while this echo feature occurs in most PD patients 1,4,5 . SNH can be found in a minority of healthy subjects (10%) and they are more likely to develop extrapyramidal signs and symptoms following administration of neuroleptic 1,2,5 .…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis between PD and atypical Parkinsonian syndromes is usually difficult in the medical practice, mainly in the beginning of clinical manifestation. Modern neuroimaging techniques, such as PET and SPECT, have proved to be useful in the clinical scenario, although expensive and inaccessible 1 .…”

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confidence: 99%

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Echogenicity of the substantia nigra region in Parkinson's disease

Bor-Seng-Shu

Almeida

Andrade

et al. 2012

Arq. Neuro-Psiquiatr.

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Idiopathic Parkinson's disease (PD) is a progressive neurodegenerative disorder which affects 1 to 2% of the population over 60 years. The differential diagnosis between PD and atypical Parkinsonian syndromes is usually difficult in the medical practice, mainly in the beginning of clinical manifestation. Modern neuroimaging techniques, such as PET and SPECT, have proved to be useful in the clinical scenario, although expensive and inaccessible 1 .Transcranial sonography (TCS) of the brain has recently emerged as a novel diagnostic test for the evaluation of movement disorders 1,2 . The authors report a patient with PD in whom TCS disclosed hyperechogenicity of the substantia nigra (SN) region; the significance of this finding (SNH) in the clinical practice was discussed. CASE REPoRTA 54-year-old female had a 16-year history of PD which followed a characteristic course with gradually worsening symptoms. Hand tremor at rest began initially on the left side and, after 3 years, both sides were affected. Current neurological examination revealed an asymmetric tremor, bradykinesia and muscle rigidity; there were posture and balance dysfunctions, and reduction of automatic movements. Results of brain CT and MRI were normal. TCS of the brain parenchyma disclosed a SN echogenic area greater than 0.20 cm 2 , bilaterally, fulfilling the criteria for SNH (Figure). Written informed consent was obtained from the patient. DiSCuSSionSNH, visualized by TCS, has been considered a biological marker for PD. This ultrasound sign is found in the majority of PD patients (>90%) and has been demonstrated to be associated with functional impairment of the nigrostriatal dopaminergic system 1-3 .Animal and human postmortem analyses have attributed increased iron content in the SN as a cause for the hyperechogenicity 1,2 . It is not known, however, whether increased SN iron levels may cause oxidative stress and secondary neuronal damage or whether SN degenerative process leads to increased iron content in the SN region 3 .SNH is less frequently encountered in essential tremor, vascular parkinsonism, multiple system atrophy and progressive supranuclear palsy while this echo feature occurs in most PD patients 1,4,5 . SNH can be found in a minority of healthy subjects (10%) and they are more likely to develop extrapyramidal signs and symptoms following administration of neuroleptic 1,2,5 .Some factors limit the usefulness of TCS, such as its dependence on the operator experience and the lack of temporal acoustic windows (about 10% of patients) 1 . No correlation Figure. Transcranial sonographic images of the midbrain. The butterfly-shaped midbrain and the substantia nigra region hyperechogenicity were encircled.

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