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July2010 Vol.47 Issue:        3       (Supp.) Table of Contents
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Progressive Supranuclear Palsy: Brainstem Measurement and its Clinical Implication

Abdelhady T. Emam1, Mohamed A. El-Sayed2, Fatma M. Awad1


Departments of Radiodiagnosis1, Neurology2, Cairo University; Egypt



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.

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