An unusual gait disorder at the Emergency Department: role of the quantitative assessment of parenchymal transcranial Doppler sonography

Godani, Massimiliano; Lanza, Giuseppe; Trevisan, Lucia; Ferri, Raffaele; Bella, Rita

doi:10.21037/qims-20-982

Cited by 5 publications

(3 citation statements)

References 33 publications

(36 reference statements)

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“…Compared with other neuroimaging modalities such as CT and MRI, pTCS is totally safe and non-invasive; it can be easily handled and repeated (e.g., through portable machines) and it has a high resistance to movement artefacts. Notably, in a few disorders, pTCS can detect abnormalities that cannot be displayed or hardly visualized through other imaging modalities, thus often representing an added diagnostic value, especially in emergency settings [ 43 ]. Compared with PD, hyperechogenicity of the LN has been reported more frequently in atypical parkinsonism, including the parkinsonian phenotype of a multiple system atrophy or progressive supranuclear palsy [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, LN hyperechogenicity has also been described in patients with Wilson’s disease [ 46 ], Creutzfeldt–Jakob disease [ 47 ], primary focal dystonia [ 48 ], Fahr’s disease [ 49 ], and pantothenate kinase-associated neurodegeneration [ 50 ]. This would suggest a common, or at least a similar, pathomechanism underlying LN hyperechogenicity, which might lie in an iron–copper–calcium accumulation and the subsequent gliosis [ 43 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

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Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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Background: Diabetic striatopathy (DS) is a rare condition with a debated pathophysiology; a local metabolic dysfunction is the most likely hypothesis. We present a case of DS mimicking an acute stroke, outline a few uncommon/atypical features, and report for the first time the parenchymal transcranial sonography (pTCS) findings. Case Report: An 86-year-old man, treated for insulin-dependent diabetes, presented at an emergency department because of the occurrence of isolated choreo-athetotic movements in his left limbs with fluctuations in the location, frequency, and duration. The blood glucose level was 569 mg/dL. Both urgent and follow-up brain computed tomography (CT) were negative for recent lesions whereas pTCS revealed hyperechogenicity in the right lenticular nucleus. Subsequent magnetic resonance imaging (MRI) showed T1-weighted hyperintensity in the right putamen with negative diffusion-weighted imaging. The symptoms were responsive to glucose control and haloperidol administration, although they persisted during sleep. Conclusions: Unlike previously described cases characterized by hemichorea and/or hemiballism, our patient presented with a stroke-like onset of unilateral irregular choreo-athetotic movements. Notably, based on CT alone, it would not have been possible to distinguish DS from a stroke. In this scenario, the pTCS hyperechogenicity of the right lenticular nucleus helped to hypothesize a metabolic disorder, which was subsequently confirmed by MRI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Godani¹,

Lanza

2022

Diagnostics

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“…Particularly, transcranial ultrasound assessment of the substantia nigra in neurodegenerative disorders can help to differentiate between Parkinson disease and essential tremor with a sensitivity of > 90% and a specificity of > 89% [ 11 ]. The usage of TCS also in emergency department setting is a promising application, since it might be able to distinguish, e.g., unclear neurological movement disorders with acute onset in patients presenting at ED [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Value of ultrasound fusion imaging in detecting vascular cerebral white matter pathology

et al. 2022

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Background Transcranial sonography is beside magnetic resonance imaging (MRI) and computed tomography, a well-established imaging method for evaluation of brain parenchyma and already implicated in various neurological disorders as bed-side investigation possibility in clinical routine. The aim of this study was the qualitative assessment detecting vascular white matter hyperintensities (WMHs), with ultrasound fusion-imaging technique (UFI) and to find the optimal location for their visualization in accordance to the grade of WMHs and to possibly providing a standardized protocol for clinical use. Results 29 patients with WMHs of variable degree quantified according to Fazekas grading scale (n = 13 I; n = 9 II; n = 7 III) and 11 subjects with normal findings on MRI were identified for further analysis. Ultrasound images were analyzed to a standardized protocol and predefined anatomical landmarks. UFI could visualize the MRI-verified WMHs in 147 of 161 localizations (91%). The overall ultrasound detection rate of WMHs increased with higher degree of WMHs burden (I:85%, II:94%, III:97%). The highest sensitivity was achieved at the contralateral central part (CPc) (97%) of the lateral ventricle. The inter-rater analysis between 2 independent raters, who were blinded to the patient’s diagnosis and assessed only the B-mode ultrasound images, indicated an 86% agreement with an overall moderate strength of agreement (κ: 0.489, p < 0.0005) for all localizations. The highest accordance within raters was shown at the CPc; 92% (κ: 0.645, p < 0.0005). Conclusions This explorative study describes prospectively the ultrasound detection of periventricular vascular WMHs based on MRI lesions using UFI. Transcranial ultrasound (TCS) could serve as an additional screening opportunity for the detection of incidental WMLs during routine TCS investigations to initiate early vascular risk factor modification in primary prevention.

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Amisulpride

2021

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An unusual gait disorder at the Emergency Department: role of the quantitative assessment of parenchymal transcranial Doppler sonography

Cited by 5 publications

References 33 publications

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Diabetic Striatopathy: Parenchymal Transcranial Sonography as a Supplement to Diagnosis at the Emergency Department

Value of ultrasound fusion imaging in detecting vascular cerebral white matter pathology

Amisulpride

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