Abstract
The differential diagnosis of parkinsonism, mainly degenerative ones, may be difficult, because there isn't any specificity of signals and symptoms. In these cases magnetic resonance and spectroscopy may be useful. A comparative, prospective case-control study was performed, with the objective of evaluating the diagnosis of parkinsonism by image. In a period of 24 months 26 patients were selected being ten with probable diagnosis of Parkinson's disease, ten with progressive supranuclear palsy, and six with multiple system atrophy. The control group consisted of ten individuals without neurological and psychiatric manifestation. Clinic assesssment was made in Clementino Fraga Filho Hospital and in the Institute of Neurology Deolindo Couto and the magnetic resonance in PrO-Cardiaco Hospital. The scales used for clinical assessement were Hoehn-Yahr, UPDRS-motor and mini-mental state examination (MMSE). Image protocols analyzed cerebral and cerebelar atrophy, signal change on white matter, lentiform nucleus and brainstem, diameter of ventricular system and structures in the brainstem. The spectroscopy (Naa/Cr and Naa/Col) was performed on lentiform nucleus, frontal lobe, hippocampus and midbrain. The results demonstrated that clinical assessment was worse on patients with multiple system atrophy and progressive supranuclear palsy through motor scales. The MMSE of patients had lower scores as compared to control group. Cerebral and cerebelar atrophy were more prevalent in progressive supranuclear palsy and multiple system atrophy, with statistic significance. The increased linear sign on putamen (dorsolateral), as well as increased sign on midbrain and pons had been observed exclusively in patients with multiple system atrophy and progressive supranuclear palsy, being these findings, therefore, suggestive of these diagnoses. Midbrain and pons diameter in progressive supranuclear palsy group was reduced as compared to others, with statistic significance. Increased ventricular system was observed more frequently and intensively in multiple system atrophy and progressive supranuclear palsy. The relations Naa/Cr of lentiforme nucleus and of hippocampus and Naa/Col of midbrain in the progressive supranuclear palsy were reduced having statistic significance. The Naa/Cr relation of hippocampus was reduced in all patients showing correlation with MMSE. The resonance and spectroscopy in selected areas was useful in the differential diagnosis between controls and Parkinson's disease versus multiple system atrophy and progressive supranuclear palsy.
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