Clinical features and differentiations of Parkinson plus syndromes

Objective To explore the clinical and imaging features of Parkinson plus syndromes and its differentiation points. Methods Seventy-three patients with idiopathic Parkinson's disease (IPD),68 patients with multiple system atrophy (MSA),10 patients with dementia of Lewy bodies (DLB),15 patients with progressive supranuclear palsy (PSP) and 6 patients with corticobasal degegnration (CBD) were recruited between January,2004 and April,2009 from our hospitals.All patients were given detailed investigation, physical examination, mini-mental status examination and brain CT/MRI examination.Part of patients were performed 18F-FDG PE.Statistical analysis was performed with SPSS 11.0 software. Results Except for postural abnormity, all the other main clinical features differed significantly between each 2 groups (P＜0.05).Brain MRI examination showed that Olivopontocerebellar atrophy was seen in 48 MSA patients (48/59,81.4％),putaminal hypointensities on T2-weighted images were seen in 4 MSA patients (4/59,6.8％) and the "hot cross bun" signal in pons was seen in 30 MSA patients (30/59, 50.8％); hummingbird-like changes were noted in midsagittal view of MRI in 3 PSP patients (3/15, 20.0％); all 6 CBD patients presented asymmetric cortical atrophy, especially in the frontoparietal areas,and 1 also presented putaminal hypointensities on T2-weighted image.Brain 18F-FDG PET indicated that 18F-FDG intake presented different distribution among groups. Conclusion Each atypical Parkinsonian syndrome has its specific clinical features which attribute to rule it out from either IPD or other Parkinson plus syndromes; brain MRI examination and 18F-PET scan can help to diagnose and differentiate Parkinson plus syndromes. Key words: Parkinson plus syndrome; Clinical feature; Magnetic resonance imaging; Positron emission tomography