Neuro imaging in movement disorders

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Neuro imaging in movement disorders

  1. 1. NEURO IMAGING INMOVEMENT DISORDERS DR. A.V. SRINIVASAN
  2. 2. Clinical Syndrome Approach 2.1. WHAT ARE THE MOVEMENTS AKINETIC OR DYSKINETIC TREMOR JERKS Myclonus Chorea Tic SPASMS Dystonia Rhythmic / arhythmic Stereo typed / in consistant Continous Action Paroxysms Slide - 2 NEURO IMAGING IN MOVEMENT DISORDERS
  3. 3. Clinical Syndrome Approach  Akinetic rigid syndrome  Dystonic syndrome  Choreic syndrome  Tic syndrome  Myoclonic syndrome Slide - 3 NEURO IMAGING IN MOVEMENT DISORDERS
  4. 4. ODD DYSKINESIAS ODDTREMOR ODD JERKS FOCAL MYOCLONUS CORTICAL MYOCLONUS GIANT SOMATO SENSORY HYPEREXPLEXIA ODD SPASMS Slide - 4 NEURO IMAGING IN MOVEMENT DISORDERS
  5. 5. Brain Iron  Iron is a key trace metal relating to brain function. The major functions in which iron performs a role include: Oxidative phosphorylation Dopamine synthesis and degradation Hydroxyl free-radical formation Slide - 5 NEURO IMAGING IN MOVEMENT DISORDERS
  6. 6. Brain Iron A. Neurodegenerative i. Parkinson’s Plus Putamen a. Striatonigral Degeneration b. Shy-Drager c. Olivopontocerebellar Atrophy ii. Hallervorden-Spatz Globus Pallidus (+ Red Nucleus / Nigra) iii.Alzheimer’s Cortical B. Metabolic i. Hypothyroidism Generalized ii. [Hepatic failure exhibits signal hyperintensity in the globus pallidus on T1 images Slide - 6 NEURO IMAGING IN MOVEMENT DISORDERS
  7. 7. Brain Iron  C. Hemorrhage Intracerebral Hematoma Site of Bleed Hemorrhagic Infarction Gyral Vascular Malformation Interstices / Margin Slide - 7 NEURO IMAGING IN MOVEMENT DISORDERS
  8. 8. Brain Iron D. Demyelination i. Multiple Sclerosis (severe) Thalamus /Putamen ii. Microangiopathic Leukoencephalopathy Putamen iii. Radiation injury White Matter/ Putamen Slide - 8 NEURO IMAGING IN MOVEMENT DISORDERS
  9. 9. INVESTIGATIONS FOR PRIMARY MOVEMENTDISORDERS  Imaging (MRI)  Exclusion of Wilson <50)  Genentic testing  Routine blood wing Biochemistry  Syphilis Slide - 9 NEURO IMAGING IN MOVEMENT DISORDERS
  10. 10. Investigation in Secondary MovementDisorders  GENERAL PLAN Extent of nervous system involvement Psychometric evaluation EEG (epilepti form discharges) ENMG (peripheral neruropathy) EMG and VEP Slide - 10 NEURO IMAGING IN MOVEMENT DISORDERS
  11. 11. Role of CT  CONDITIONS THAT MAY PRODUCE WHITE MATTER CHANGE ON BRAIN CT OR MRI AND WHICH MAY CAUSE MOVEMENT DISORDERS. Alexander’s disease Krabbe’s disease Polycystic lipomembranous osteodyplasia Adeno – myelo – Leukodystrophy Metachromatic leukodystrophy Mitrochondrial diorders. Slide - 11 NEURO IMAGING IN MOVEMENT DISORDERS
  12. 12. DEGENERATIVE AND SYSTEMIC DISORDERS  Polyeystic lipomembraneous Hand X-rays, skin biopsy  Degeneration  Hallervorden Spatz disease Brain MRI  Pallidal degenerations Brain MRI  Alzheimer’s disease Brain MRI  Multi – infarct state Brain MRI  Binswanger’s subcortical arteriosclerotic Brain MRI Encephalopathy  Normal pressure hydrocephalus Brain MRI  Dementia pugilistica Brain MRI  Calcification of the basal ganglia Brain CT and MRI  Cerebral anoxia (Co and cyanide poisoning) Brain MRI Slide - 12 NEURO IMAGING IN MOVEMENT DISORDERS
  13. 13. Wilson’s Disease  3 movement disorders Akinetic-rigid syndrome resembling Parkinsonism Dystonic syndrome Postural and intentional tremor  Clinical Tremor, rigidity, gait difficulty Bulbar signs: indistinct speech, dysphagia Hepatic encephalopathy Anemia (10%) Slide - 13 NEURO IMAGING IN MOVEMENT DISORDERS
  14. 14. Wilson’s Disease  Dx  Kayser-Fleischer ring  Elevated urinary copper  Decreased serum ceruloplasmin  Elevated bepatic copper  CT DDX  Straiatonigraldegeneration  Metabolic acidosis  Leigh disease  2o parkinsonism  acquired hepatocerebral degeneration  myeliolysis  HIE Slide - 14 NEURO IMAGING IN MOVEMENT DISORDERS
  15. 15. Wilson’s Disease  MR Altered GM and WM signal intensities Atrophy of caudate head, brain stem Cerebral and cerebellar atrophy  MR: 3 patterns T1 PD/T2 Variable increased increased variable variable decreased Slide - 15 NEURO IMAGING IN MOVEMENT DISORDERS
  16. 16. Wilson’s Disease  Type I  Putamen, GP, thalamus  Caudate, claustrum, subthalamus  Red nucleus, substantia nigra  Dentate  Type II  Globus pallidus  Rarely putamen, caudate  Type III  Basalganglia  Thalamus  Dentate nucleus  Superior colliculus Slide - 16 NEURO IMAGING IN MOVEMENT DISORDERS
  17. 17. Metabolic  Metabolic disorders: Gray Matter Huntington’s disease Hepatocerebral disorders Mitochondrial cytompathies CO, CO3 poisoning Striatonigral degeneration Pyruvate dehydrogenase deficiency Hallervorden-Spatz disease Slide - 17 NEURO IMAGING IN MOVEMENT DISORDERS
  18. 18. Wernicke-Korsakoff Syndrome  MR Abnormal signal in mamillary bodies Periventricular thalamus Periaqueductal gray + enhancement Slide - 18 NEURO IMAGING IN MOVEMENT DISORDERS
  19. 19. PRES: Posterior Reversible EncephalopathySyndrome  Imaging Subcortical involvement Basal ganglia, brainstem unusual Cerebellar involvement occasional Enhancement/hemorrhage unusual Slide - 19 NEURO IMAGING IN MOVEMENT DISORDERS
  20. 20. Hemochromatosis MR hypointensity of basal ganglia, thalami central white matter adenohypophysis choroids plexus Slide - 20 NEURO IMAGING IN MOVEMENT DISORDERS
  21. 21. Degenerative Disorders  Diseases of the Substantia Nigra Parkinson’s disease Progressive supranuclear palsy Straitonigral degeneration Hallervorden – Spatz disease Slide - 21 NEURO IMAGING IN MOVEMENT DISORDERS
  22. 22. Parkinson’s Disease  MR Diminished width of pars compacta Normal putamina  MR-guided Pharmacotherapy Intracerebroventricular drug delivery Parenchymal drug delivery Huge population of new patients with neurodegenerative disorders potentially amenable to targeted pharmacotherapy Slide - 22 NEURO IMAGING IN MOVEMENT DISORDERS
  23. 23. Parkinson’s Disease  Progressive Supranuclear Palsy  Pathology Atrophy of mesencephalon Periaqueductal gliosis and neurofibrillary tangles  MR Subtle enlargement of aqueduct Subtle atrophy of periaqueductal gray Slide - 23 NEURO IMAGING IN MOVEMENT DISORDERS
  24. 24. Parkinson’s Disease  MR Diminished width of pars compacta Hypointense dorsolateral putamina  Hallervorden – Spatz Disease Gradual limb stiffness Dysarthria, dementia 50% exhibit choreiform or athetosis marked symmetric T2-shortening  globipallidi  + pars reticularis eye of the tiger appearance Slide - 24 NEURO IMAGING IN MOVEMENT DISORDERS
  25. 25. Differentiation  Signal Hypointensity T2 <Putamen>  Parkinson’s Plus (Multiple System Atrophy)  Hypothyroidism  Signal Hyperintensity T2 <Putamen>  Wilson’s  Familial Striatal Degeneration  Creutzfeldt jakob  Anoxia  Leigh’s  Ophthalmoplegia Plus  Pallidoluysian Degeneration  Signal Hyperintensity T1 <Globus Pallidus>  Hepatic insufficiency  Anoxia (petechial hemorrhage) Slide - 25 NEURO IMAGING IN MOVEMENT DISORDERS

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