Computed tomographic findings of progressive supranuclear palsy compared with Parkinson's disease.

Abstract

We investigated computed tomographic (CT) films of 4 pathologically documented cases of progressive supranuclear palsy (PSP) in which the clinical presentations were atypical and compared the findings with those of 15 patients with Parkinson's disease (PD). Dilatation of the third ventricle, atrophy of the midbrain tegmentum, and enlargement of the interpeduncular cistern toward the aqueduct were found to be the characteristic findings in PSP. Thus, radiological findings can be useful when the differential diagnosis between PSP and PD is clinically difficult.

Cerebral Peduncle Angle: An Objective Criterion for Assessing Progressive Supranuclear Palsy Richardson Syndrome

“…Such changes of midbrain atrophy cause some of the signs described in the imaging literature, including the hummingbird sign, which refers to the appearance of the midbrain on midline sagittal T1-weighted MR images, and the Mickey Mouse sign, which reflects the appearance of the cerebral peduncles on axial T1-weighted MR images [22,23]. These changes of midbrain atrophy subsequently result in prominence of the adjacent cisterns [25,26]. Yuki et al [25] found dilatation of the third ventricle, atrophy of the midbrain tegmentum, and enlargement of the interpeduncular cistern to be characteristic cross-sectional imaging findings in patients with PSP.…”

“…These changes of midbrain atrophy subsequently result in prominence of the adjacent cisterns [25,26]. Yuki et al [25] found dilatation of the third ventricle, atrophy of the midbrain tegmentum, and enlargement of the interpeduncular cistern to be characteristic cross-sectional imaging findings in patients with PSP. Righini et al [26] found progressive enlargement of the interpeduncular cistern in patients with PSP.…”

Imaging Criteria for the Diagnosis of Progressive Supranuclear Palsy: Supportive or Mandatory?

“…The patients with PSP had marked dilation of the lateral and third ventricles, as well as the prepontine cistern. Likewise, Yuki et al compared the CT scans of four pathologically confirmed cases of PSP with those of 15 patients diagnosed with Parkinson's disease and concluded that midbrain atrophy with dilation of the third ventricle and interpeduncular cistern was characteristic of PSP [8]. Last but not least, in the study performed by Massuci, all 10 patients diagnosed with PSP had increased midbrain atrophy with moderate atrophy of the pons, dilation of the third ventricle, and enlarged quadrigeminal plate cisterns.…”

Cerebral peduncle angle: Unreliable in differentiating progressive supranuclear palsy from other neurodegenerative diseases

“…As tegmental atrophy progresses, the cerebral peduncles seem to invaginate toward the tegmentum, which may result in a narrower CPA. In fact, it has been suggested that the interpeduncular cistern enlarged toward the aqueduct as a result of this invagination in pathologically confirmed PSP patients [21]. Serial evaluation of the CPA in each patient would be warranted to demonstrate actual temporal changes of the CPA in PSP.…”

“…Yuki et al observed that patients with PSP had interpeduncular cistern enlargement, which was later shown to be progressive [16, 21]. Fatterpekar and colleagues quantified midbrain atrophy by calculating an angle between the cerebral peduncles on magnetic resonance imaging (MRI).…”