The diagnostic accuracy of the hummingbird and morning glory sign in patients with neurodegenerative parkinsonism

Mueller, Christoph; Hussl, Anna; Krismer, Florian; Heim, Beatrice; Mahlknecht, Philipp; Nocker, Michael; Scherfler, Christoph; Mair, Katherina J.; Esterhammer, Regina; Schocke, Michael; Wenning, Gregor K.; Poewe, Werner; Seppi, Klaus

doi:10.1016/j.parkreldis.2018.04.005

Cited by 56 publications

(51 citation statements)

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“…Structural MRI typically shows atrophy of the midbrain and SCP in PSP compared to PD, MSA-P, CBD/CBS and controls ( 121 – 124 ). Several morphological markers suggestive of PSP on MRI have been reported, including midbrain atrophy compared to pons (“hummingbird” sign; specificity ~99.5%, sensitivity ~51%; Figure 5 ), atrophy of the midbrain tegmentum (“morning glory” sign, specificity ~97%, sensitivity ~37%; visualized as concavity of the lateral margins of the midbrain tegmentum on axial images; Figure 5 ) ( 125 – 127 ), midbrain T2 hyperintensity, as well as atrophy of the midbrain tegmentum with relative preservation of the midbrain tectum and cerebral peduncles (“mickey mouse” sign, visualized as rounded rather than rectangular midbrain peduncles on axial images) ( 99 , 125 ). Importantly, the “hummingbird” and “morning glory” signs had high specificity but low sensitivity ( 99 ).…”

Section: Structural Neuroimaging In Parkinsonian Disordersmentioning

confidence: 99%

Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes

2020

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Section: Structural Neuroimaging In Parkinsonian Disordersmentioning

confidence: 99%

Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes

2020

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“…[8][9][10][11][12] Indeed, MDS-PSP criteria include imaging findings as supportive features. However, the assessment of midbrain atrophy by magnetic resonance imaging (MRI) has weak sensitivity in the early stages, 13 and postsynaptic striatal dopaminergic degeneration fails to differentiate neurodegenerative parkinsonism. 14 Fluorodeoxyglucose positron emission tomography (FDG-PET) imaging as a marker of neuronal damage 15 could be a useful tool to achieve a differential diagnosis of neurodegenerative parkinsonism in relative early stages.…”

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confidence: 99%

Multicenter Validation of Metabolic Abnormalities Related to PSP According to the MDS‐PSP Criteria

et al. 2020

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It remains unclear whether the supportive imaging features described in the diagnostic criteria for progressive supranuclear palsy (PSP) are suitable for the full clinical spectrum. The aim of the current study was to define and cross-validate the pattern of glucose metabolism in the brain associated with a diagnosis of different PSP variants. A retrospective multicenter cohort study performed on 73 PSP patients who were referred for a fluorodeoxyglucose positron emission tomography PET scan: PSP-Richardson's syndrome, n = 47; PSP-parkinsonian variant, n = 18; and progressive gait freezing, n = 8. In addition, we included 55 healthy controls and 58 Parkinson's disease (PD) patients. Scans were normalized by global mean activity. We analyzed the regional differences in metabolism between the groups. Moreover, we applied a multivariate analysis to obtain a PSP-related pattern that was cross-validated in independent populations at the individual level. Group analysis showed relative hypometabolism in the midbrain, basal ganglia, thalamus, and frontoinsular cortices and hypermetabolism in the cerebellum and sensorimotor cortices in PSP patients compared with healthy controls and PD patients, the latter with more severe involvement in the basal ganglia and occipital cortices. The PSP-related pattern obtained confirmed the regions described above. At the individual level, the PSPrelated pattern showed optimal diagnostic accuracy to distinguish between PSP and healthy controls (sensitivity, 80.4%; specificity, 96.9%) and between PSP and PD (sensitivity, 80.4%; specificity, 90.7%). Moreover, PSP-Richardson's syndrome and PSP-parkinsonian variant patients showed significantly more PSP-related pattern expression than PD patients and healthy controls. The glucose metabolism assessed by fluorodeoxyglucose PET is a useful and reproducible supportive diagnostic tool for PSP-Richardson's syndrome and PSP-parkinsonian variant.

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“…The specificity and positive predictive value of this sign are 99.5% and 96.1% correspondingly yet low sensitivity of 51.6%. 12,13 Vascular Cognitive Impairment According to American Heart Association and American Stroke Association (AHA/ASA), vascular cognitive impairment VCI is "a syndrome with evidence of clinical stroke or subclinical vascular brain injury and cognitive impairment affecting at least one cognitive domain." Risk factors of developing VCI include increasing age, low education, female, history of stroke, global and medial temporal atrophy (found from neuroimaging), late life depression, and vascular risk factors, namely hypertension, smoking, history of ischemic heart disease, dyslipidemia, atrial fibrillation, diabetes mellitus, and obesity.…”

Section: Case Report Open Accessmentioning

confidence: 99%

“…Significant imaging findings in PSP are hummingbird sign (figure 2) and morning glory sign (figure 3). 12 Morning glory sign results from midbrain tegmentum atrophy and cerebral peduncles thinning causing a concavity of the lateral margin of midbrain tegmentum. The specificity of morning glory sign is 97.7% but the sensitivity is 36.8%.…”

Section: Case Report Open Accessmentioning

confidence: 99%

Clinical and Radiologic Approach to Probable Mixed Dementia (Vascular Dementia and Progressive Supranuclear Palsy)

Lastri

Alwahdy

2020

MNJ

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Dementia as a global burden neurodegenerative disease need to be diagnosed as earlier as possible then treated accordingly. The varying aetiologies of dementia render specific diagnosis of dementia challenging. Other than clinical syndromes, cognitive function examination and neuroimaging are also important to determine the correct dementia diagnosis. This paper aims to provide a dementia case where the working diagnosis could not be decided at once and to show how cognitive function examination and neuroimaging are essential to determine the diagnosis. This paper reports an 80-year old male with dementia symptoms that was followed and regularly examined for one year. With time, additional neurological symptoms were observed thus the working diagnosis was established. The patient was diagnosed with mixed dementia that consisted of probable vascular cognitive impairment and probable progressive supranuclear palsy.

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The diagnostic accuracy of the hummingbird and morning glory sign in patients with neurodegenerative parkinsonism

Abstract: Midbrain atrophy patterns are useful in the differential diagnosis of neurodegenerative parkinsonism but both the hummingbird sign and more so the morning glory flower sign suffer from low sensitivity, especially in early disease stages.

Cited by 56 publications

References 14 publications

Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes

Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes

Multicenter Validation of Metabolic Abnormalities Related to PSP According to the MDS‐PSP Criteria

Clinical and Radiologic Approach to Probable Mixed Dementia (Vascular Dementia and Progressive Supranuclear Palsy)

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