Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism
Abstract Objectives The classic triad of idiopathic normal pressure hydrocephalus (NPH) encompass gait disturbance, cognitive impairment, and urinary incontinence. These symptoms overlap with parkinsonism but with distinct treatment. Lacking applicable differentiation also hampers the prediction to...
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Brain and Behavior |
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| Online Access: | https://doi.org/10.1002/brb3.2884 |
| _version_ | 1828033411525115904 |
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| author | Mu‐Hui Fu Chih‐Cheng Huang Kay L. H. Wu Ying‐Fa Chen Yu‐Chih Kung Cheng‐Chang Lee Jia‐Shou Liu Min‐Yu Lan Yung‐Yee Chang |
| author_facet | Mu‐Hui Fu Chih‐Cheng Huang Kay L. H. Wu Ying‐Fa Chen Yu‐Chih Kung Cheng‐Chang Lee Jia‐Shou Liu Min‐Yu Lan Yung‐Yee Chang |
| author_sort | Mu‐Hui Fu |
| collection | DOAJ |
| description | Abstract Objectives The classic triad of idiopathic normal pressure hydrocephalus (NPH) encompass gait disturbance, cognitive impairment, and urinary incontinence. These symptoms overlap with parkinsonism but with distinct treatment. Lacking applicable differentiation also hampers the prediction to therapeutic response. Here, we try to clarify this issue among different Parkinsonian syndromes and propose some innovative thinking while approaching a patient with parkinsonism and hydrocephalus concomitantly. Methods Twenty‐four patients with clinical probable multiple system atrophy (MSA), 34 with probable progressive supranuclear palsy (PSP), and 58 with sex‐ and age‐matched Parkinson's disease (PD) were enrolled. Evans’ index (EI), callosal angle (CA), antero‐posterior (AP) diameter of the midbrain, length of the midbrain tegmentum diameter (MBTegm), and disproportionately enlarged subarachnoid space hydrocephalus (DESH) were evaluated using the conventional MRI. Logistic regression was applied to identify the independent variables in hydrocephalus. Results Patients with PSP had higher mean EI than those with MSA and PD. Around 38.2% of patients with PSP had accompanied hydrocephalus (EI > 0.3). Parkinsonism subtypes (PD, MSA, or PSP), AP diameter of the midbrain, and MBTegm were significantly different among patients with and without hydrocephalus. After regression analysis, parkinsonism subtype stood out to be the most key risk factor of hydrocephalus. The comparison between patients with PSP with and without hydrocephalus did not disclose specific clinical characteristics or risk factors. Conclusions This study demonstrates that the presence of NPH‐like MRI features is much higher in PSP patients, and this tendency is decided upon the determination of parkinsonism subtype. Sharing pathophysiological characteristics in these two diseases is implied. More diagnostic tools are needed to better differentiate the two diseases and decide the treatment. To closely observe hydrocephalic parkinsonism patients and well inform the possible limited shunting benefits if PSP core features appear, will be more pivotal and practical at present clinical practice. |
| first_indexed | 2024-04-10T15:19:15Z |
| format | Article |
| id | doaj.art-4ca1dde6a62647f5b2f363ad6db089d6 |
| institution | Directory Open Access Journal |
| issn | 2162-3279 |
| language | English |
| last_indexed | 2024-04-10T15:19:15Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Brain and Behavior |
| spelling | doaj.art-4ca1dde6a62647f5b2f363ad6db089d62023-02-14T16:52:41ZengWileyBrain and Behavior2162-32792023-02-01132n/an/a10.1002/brb3.2884Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonismMu‐Hui Fu0Chih‐Cheng Huang1Kay L. H. Wu2Ying‐Fa Chen3Yu‐Chih Kung4Cheng‐Chang Lee5Jia‐Shou Liu6Min‐Yu Lan7Yung‐Yee Chang8Department of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanInstitute for Translational Research in Biomedicine Kaohsiung Chang Gung Memorial Hospital Kaohsiung TaiwanDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanDepartment of Nursing Meiho University Pingtung County TaiwanDepartment of Radiology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung TaiwanDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanDepartment of Neurology, Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Kaohsiung TaiwanAbstract Objectives The classic triad of idiopathic normal pressure hydrocephalus (NPH) encompass gait disturbance, cognitive impairment, and urinary incontinence. These symptoms overlap with parkinsonism but with distinct treatment. Lacking applicable differentiation also hampers the prediction to therapeutic response. Here, we try to clarify this issue among different Parkinsonian syndromes and propose some innovative thinking while approaching a patient with parkinsonism and hydrocephalus concomitantly. Methods Twenty‐four patients with clinical probable multiple system atrophy (MSA), 34 with probable progressive supranuclear palsy (PSP), and 58 with sex‐ and age‐matched Parkinson's disease (PD) were enrolled. Evans’ index (EI), callosal angle (CA), antero‐posterior (AP) diameter of the midbrain, length of the midbrain tegmentum diameter (MBTegm), and disproportionately enlarged subarachnoid space hydrocephalus (DESH) were evaluated using the conventional MRI. Logistic regression was applied to identify the independent variables in hydrocephalus. Results Patients with PSP had higher mean EI than those with MSA and PD. Around 38.2% of patients with PSP had accompanied hydrocephalus (EI > 0.3). Parkinsonism subtypes (PD, MSA, or PSP), AP diameter of the midbrain, and MBTegm were significantly different among patients with and without hydrocephalus. After regression analysis, parkinsonism subtype stood out to be the most key risk factor of hydrocephalus. The comparison between patients with PSP with and without hydrocephalus did not disclose specific clinical characteristics or risk factors. Conclusions This study demonstrates that the presence of NPH‐like MRI features is much higher in PSP patients, and this tendency is decided upon the determination of parkinsonism subtype. Sharing pathophysiological characteristics in these two diseases is implied. More diagnostic tools are needed to better differentiate the two diseases and decide the treatment. To closely observe hydrocephalic parkinsonism patients and well inform the possible limited shunting benefits if PSP core features appear, will be more pivotal and practical at present clinical practice.https://doi.org/10.1002/brb3.2884atypical parkinsonismidiopathic normal pressure hydrocephalusParkinson's diseaseprogressive supranuclear palsy |
| spellingShingle | Mu‐Hui Fu Chih‐Cheng Huang Kay L. H. Wu Ying‐Fa Chen Yu‐Chih Kung Cheng‐Chang Lee Jia‐Shou Liu Min‐Yu Lan Yung‐Yee Chang Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism Brain and Behavior atypical parkinsonism idiopathic normal pressure hydrocephalus Parkinson's disease progressive supranuclear palsy |
| title | Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism |
| title_full | Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism |
| title_fullStr | Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism |
| title_full_unstemmed | Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism |
| title_short | Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism |
| title_sort | higher prevalence of idiopathic normal pressure hydrocephalus like mri features in progressive supranuclear palsy an imaging reminder of atypical parkinsonism |
| topic | atypical parkinsonism idiopathic normal pressure hydrocephalus Parkinson's disease progressive supranuclear palsy |
| url | https://doi.org/10.1002/brb3.2884 |
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