2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane and Brain-Infarction

Topics: Aged; Brain Infarction; Diagnosis, Differential; Disease Progression; Female; Humans; Mesencephalon; Parkinson Disease, Secondary; Positron-Emission Tomography; Radiopharmaceuticals; Tropanes

Cerebral vascular lesions are integral to the diagnosis of vascular parkinsonism (VP). The VP, also referred to as lower body parkinsonism, is frequently caused by subcortical white matter lesions, but lesions at any levels of the nigro-striato-thalamo-cortical pathway can also cause VP, thus giving rise to various symptoms other than gait disturbance. Previous dopamine transporter imaging studies using SPECT showed heterogeneous patterns suggesting diverse contributing lesions to VP. Here we present 3 cases of VP demonstrated by F-FP-CIT PET/CT, visualizing vascular lesions at different levels between the midbrain and motor cortex. Distinctive clinical manifestations of them recapitulate the pathogenesis of VP.

Topics: Aged; Brain Infarction; Female; Humans; Parkinson Disease, Secondary; Positron Emission Tomography Computed Tomography; Tropanes

I-FP-CIT SPECT is widely used for diagnosis in patients with parkinsonism. Vascular parkinsonism usually has nonspecific findings from normal uptake to radiotracer decrease in the infarcted region. Infarction of the substantia nigra has been reported as a rare cause of vascular parkinsonism. We present a case of artery of Percheron infarction involving the substantia nigra unilaterally with ipsilateral reduction of striatal uptake on I-FP-CIT SPECT, suggesting anterograde degeneration of the nigrostriatal pathway. Infarction of the substantia nigra should be considered in cases of decreased striatal uptake with marked laterality on I-FP-CIT SPECT.

Topics: Aged, 80 and over; Anatomic Variation; Arteries; Brain Infarction; Corpus Striatum; Humans; Infarction, Posterior Cerebral Artery; Magnetic Resonance Imaging; Male; Neostriatum; Neural Pathways; Neurodegenerative Diseases; Parkinsonian Disorders; Posterior Cerebral Artery; Radiopharmaceuticals; Substantia Nigra; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Brain Infarction; Caudate Nucleus; Dopamine Plasma Membrane Transport Proteins; Hand; Humans; Iodine Isotopes; Male; Middle Aged; Nortropanes; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon; Tremor

Elderly patients with recurrent falls are frequently diagnosed with an extrapyramidal syndrome. This study aims to characterise a distinct group of patients with recurrent falls and postural instability as a hallmark of the clinical examination. The study took place in the Movement Disorders Unit, Rabin Medical Center, Petah Tiqva, Israel among 26 patients with recurrent falls who had no clinical evidence of a neurodegenerative disease. Medical records, neurological examination and brain imaging studies were assessed. Falls in these patients were sudden, unprovoked, with no vertigo or loss of consciousness. All had postural instability with minimal or no abnormality on the neurological examination. Brain imaging showed diffuse ischaemic changes in 65%. [(123)I]-FPCIT SPECT with the dopamine transporter ligand, performed in five patients, was normal in all. Recurrent falls might be caused by a neurological syndrome that primarily affects balance control. The importance of identifying this disorder is its distinction from other parkinsonian syndromes causing falls.

Topics: Accidental Falls; Aged; Aged, 80 and over; Basal Ganglia Diseases; Brain Infarction; Female; Humans; Iodine Radioisotopes; Male; Movement Disorders; Neurodegenerative Diseases; Neurologic Examination; Postural Balance; Posture; Tomography, Emission-Computed, Single-Photon; Tropanes