Transcranial sonography in movement disorders: an interesting tool for diagnostic perspectives

Abstract

Transcranial sonography has become an important tool for the diagnosis of various movement disorders. In most patients with idiopathic Parkinson disease, a markedly hyperechogenic substantia nigra (SN) was detected on at least one side. We have highlighted the sonographic features that might help the differential diagnosis of PD and other movement disorders. Our investigation involved 30 patients (age 45-85 years) with idiopathic Parkinson disease, 2 multiple system atrophy, 3 progressive supranuclear palsy and 2 patients with restless legs syndrome. In accordance with several previous studies, we detected hyperechogenicity of the SN by TCS in 90% of patients with idiopathic Parkinson disease. Subjects with a marked severity disease had a larger extent of the hyperechogenic SN signal. All progressive supranuclear palsy patients had an enlarged third ventricle and, in two cases, we observed the presence of hyperechoic areas in the lentiform nucleus. This last ultrasonographic feature was also seen in our patients with multiple system atrophy. TCS abnormalities of the SN, midbrain raphe and basal ganglia are characteristics of several movement and affective disorders. These features are less easily detected by other techniques, such as CT and MRI, which enable the exclusion of structural lesions, such as tumours and multi-infarct disease, because the physical principle differs from other imaging methods.

Transcranial Sonography of the Substantia Nigra for the Differential Diagnosis of Parkinson’s Disease and Other Movement Disorders: A Meta-Analysis

“…Nine related studies [12][13][14][15][16][17][18][19][20] with a total of 1046 participants, which included 669 patients with PD, published between January 2015 and May 2020, with sample sizes ranging from 35 to 409, were included in the final meta-analysis. e diseases differentiated from PD included atypical Parkinsonism (AP), ET, vascular Parkinsonism (VP), isolated adult-onset focal dystonia (FD), and dopa-responsive dystonia (DRB).…”

Lentiform Nucleus Hyperechogenicity in Parkinsonian Syndromes: A Systematic Review and Meta-Analysis with Consideration of Molecular Pathology

“…After assessing the abstracts, 135 articles were excluded. The remaining 15 [7,12,[15][16][17][18][19][20][21][22][23][24][25][26][27] articles were included in our meta-analysis. These 15 articles provided the data of overall 1330 patients with a sufficient bone window subdivided into 1091 PD and 239 aPS (MSA-P and PSP) patients.…”

Substantia Nigra Hyperechogenicity for the Early Detection of Parkinson’s Disease

“…This classification is further supported by the fact that SN+ can also be found in very young ages unlikely to have neurodegeneration [27]. However, although the majority of the published data describe SN+ as a stable marker, some more recent studies report correlation with disease severity or transporter uptake [28,29]. This may be due to a better resolution of modern ultrasound devices and thus more accurate measurements.…”