Background: Accurate clinical differentiation of progressive supranuclear palsy (PSP) from other extrapyramidal syndromes may be difficult. Objective: To detect the value of mid-sagittal MRI measurements of the midbrain and pons in the diagnosis of progressive supranuclear palsy (PSP) and to differentiate it from mimics [Parkinson Disease (PD) and Multiple-System Atrophy of Parkinson Type (MSA-P)], and to what extent these radiological measurements correlate with the clinical aspects of PSP. Methods: MRI of 11 patients with PSP, 25 patients with PD, and 8 patients with MSA-P, as well as 20 age-matched controls were prospectively studied. The areas of the midbrain tegmentum and the pons were measured on mid-sagittal MRI. Patients were also evaluated clinically using Hoehn and Yahr Scale, Unified Parkinson's Disease Rating Scale (UPDRS) and Mini-Mental State Examination (MMSE) scale in addition to full general and neurological assessment and routine laboratory investigations. Results: The mean midbrain area and the ratio of midbrain area to the pontine area of PSP patients were significantly smaller than that of the PD patients, MSA-P patients and the age matched control group. In PSP patients, the radiological measurements studied correlated significantly with disease duration, staging and severity. Conclusion: Mid-sagittal MRI measurements of the midbrain area are reliable diagnostic criteria that can differentiate progressive supranuclear palsy from other common extrapyramidal syndromes and normal aging. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 355-360]
Keywords: Progressive supranuclear palsy (PSP), Magnetic resonance imaging (MRI), Clinical assessment.
Correspondence to Mohamed Ahmed El-Sayed. Department of Neurology, Cairo University, Egypt.
Tel.: +20123713914. Email: dr_mawady@yahoo.com