2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane and Muscle-Rigidity

To report a case of a patient infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who acutely developed a hypokinetic-rigid syndrome.. Patient data were obtained from medical records from the Hospital Universitario 12 de Octubre in Madrid, Spain. [. We report a previously healthy 58-year-old man who developed hyposmia, generalized myoclonus, fluctuating and transient changes in level of consciousness, opsoclonus, and an asymmetric hypokinetic-rigid syndrome with ocular abnormalities after a severe SARS-CoV-2 infection. DaT-SPECT confirmed a bilateral decrease in presynaptic dopamine uptake asymmetrically involving both putamina. Significant improvement in the parkinsonian symptoms was observed without any specific treatment.. This case study provides clinical and functional neuroimaging evidence to support that SARS-CoV-2 can gain access to the CNS, affecting midbrain structures and leading to neurologic signs and symptoms.

Topics: Betacoronavirus; Brain; Consciousness Disorders; Coronavirus Infections; COVID-19; Disease Progression; Dopamine Plasma Membrane Transport Proteins; Electroencephalography; Humans; Hypokinesia; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Rigidity; Nortropanes; Ocular Motility Disorders; Pandemics; Parkinson Disease, Postencephalitic; Pneumonia, Viral; Putamen; SARS-CoV-2; Tomography, Emission-Computed, Single-Photon

Total parkinsonian motor symptom severity correlates with presynaptic striatal dopamine function in patients with Parkinson's disease. There is a lack of studies that have investigated the associations between parkinsonian motor signs and striatal dopaminergic deficiency in patients with parkinsonism of an unknown origin. Identification of specific motor signs associated with the highest likelihood of striatal dopamine deficiency could aid the differential diagnostics of parkinsonian and tremor syndromes.. In this cross-sectional clinical and imaging study, detailed motor examinations were performed for 221 patients with parkinsonism or tremor of an unknown origin immediately before dopamine transporter (DAT) [I-123]FP-CIT SPECT imaging. Region-of-interest and voxel-based methods were used to investigate striatal DAT deficiency in relation to individual motor signs.. Upper extremity rigidity and facial expression were the only motor signs that differentiated patients with normal and abnormal striatal DAT function. The presence of any upper extremity rigidity showed the highest likelihood of DAT deficiency (OR 4.79, 95% CI 1.56-14.75, P = 0.006) followed by reduced facial expression (OR 2.14, 95% CI 1.14-4.00, P = 0.018). In patients with DAT deficits, reduced facial expression was associated with DAT deficiency specifically in the caudate nucleus, and increased upper extremity rigidity was associated with DAT loss in the dorsal putamen (FWE-corrected P < 0.05).. Increased upper extremity muscle tone and hypomimia are independently associated with a higher likelihood of striatal hypodopaminergic imaging finding. This information can be used as a factor when the clinical need of auxiliary investigations, such as DAT SPECT, is considered for patients with parkinsonism.

Topics: Aged; Brain Mapping; Corpus Striatum; Cross-Sectional Studies; Dopamine Plasma Membrane Transport Proteins; Facial Expression; Female; Humans; Male; Middle Aged; Muscle Rigidity; Parkinsonian Disorders; Prospective Studies; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes; Upper Extremity

The demonstration of presynaptic dopaminergic deficiency on [. Our primary aim was to assess the correlations between dopaminergic deficiency on baseline [. 42 PD patients with abnormal baseline [. The degree of dopaminergic deficiency on baseline [

Topics: Aged; Disease Progression; Female; Humans; Male; Middle Aged; Muscle Rigidity; Parkinson Disease; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes

To elucidate whether Parkinson's disease subtypes show a different pattern of Iodine-123 fluoropropyl-;carbomethoxy-3 β-(FP-CIT) single photon emission computed tomography (SPECT) binding in accordance with neuropathological findings.. We analyzed a database of consecutive patients with FP-CIT scan (n = 190) over a 3-year period and identified 122 patients (50 women, 72 men, mean age 62 ± 11.1 years) with a diagnosis of idiopathic Parkinson's disease. Patient's characteristics and FP-CIT scan results were analyzed and compared for the subgroups tremor-dominant versus akinetic-rigid and equivalent type of Parkinson's disease.. The analysis of all Parkinson's disease patients showed a significant difference between the FP-CIT uptake in the subgroups tremor-dominant and akinetic-rigid. After matching these samples for age, disease duration, disease severity (Hoehn & Yahr grade, Unified Parkinson's Disease Rating Scale score), and levodopa-equivalent dose, these findings were balanced between both groups (n = 23/23) without a significant difference (P > 0.05). However, there was a clear, significant association of visually analyzed shapes of the striatum in FP-CIT SPECT and clinical Parkinson's disease subtype.. These results confirm neuropathological models for a reduced dopaminergic projection to the dorsal putamen in akinetic-rigid patients as well as the lateral putamen and caudate nucleus in tremor-dominant patients in vivo.

Topics: Aged; Brain Mapping; Corpus Striatum; Female; Fluorine Radioisotopes; Humans; Male; Middle Aged; Muscle Rigidity; Parkinson Disease; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tremor; Tropanes

The aim of this study was to assess the ability of a single SPECT performed in the early stage of Parkinson's disease (PD) to predict disease severity in 19 patients with early PD. [(123)I]-FP-CIT striatal uptake was expressed as a ratio of specific:nonspecific uptake for defined brain areas. Clinical severity was determined by the UPDRS at baseline and 12-15 months following the SPECT procedure. [(123)I]-FP-CIT uptake in the contralateral putamen and striatum was correlated with UPDRS score at baseline, with a more significant correlation after 1-year interval. [(123)I]-FP-CIT uptake in all areas was correlated with bradykinesia and rigidity subscores only at follow up visit. Significant correlations were found between [(123)I]-FP-CIT uptake in the contralateral striatum, putamen and caudate and the difference between motor scores of 1-year interval (DeltaUPDRS). These results suggest that disease severity might be anticipated by a single SPECT at an early stage of the disease.

Topics: Adult; Aged; Dyskinesias; Female; Follow-Up Studies; Humans; Male; Middle Aged; Muscle Rigidity; Neostriatum; Neurologic Examination; Parkinson Disease; Putamen; Radiopharmaceuticals; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; Tropanes

In idiopathic Parkinson's disease (PD), a tremor-dominant type (TDT), an akinetic-rigid type (ART), and a mixed type (MT) are distinguished. We compared cerebral [I-123]FP-CIT SPECT in the PD subtypes (67 patients Hoehn and Yahr stage 1:26 with ART, 19 with MT, 22 with TDT). We measured the ratios putamen/occipital lobe binding and caudate nucleus/occipital lobe binding. Parkinsonian motor symptoms were quantified by UPDRS motor scale. In both putamen and caudate nucleus contralateral to the clinically affected body side TDT patients showed a significantly higher FP-CIT uptake than ART or MT patients (ANOVA; p<0.01). Contralateral putamen and caudate nucleus FP-CIT uptake correlated significantly with severity of rigidity (p<0.01) and hypokinesia (p<0.01) but not with severity of resting or postural tremor (p>0.05). The missing correlation between striatal FP-CIT uptake and tremor suggests, that further systems besides the nigrostriatal dopaminergic system may contribute to generation of parkinsonian tremor.

Topics: Adult; Age of Onset; Aged; Binding, Competitive; Caudate Nucleus; Corpus Striatum; Diagnosis, Differential; Disease Progression; Dopamine; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Male; Middle Aged; Muscle Rigidity; Occipital Lobe; Parkinson Disease; Predictive Value of Tests; Putamen; Substantia Nigra; Tomography, Emission-Computed, Single-Photon; Tremor; Tropanes

Extrapyramidal symptoms are observed in frontotemporal dementia (FTD). (123)I-FP-CIT (DaT scan) single photon emission computed tomography (SPECT) can detect loss of presynaptic dopamine transporters in the striatum. We aimed to evaluate the dopaminergic status of the striatum in patients with FTD using DaT scan. Seven patients (age range 65-76 years), who fulfilled the Neary criteria and in whom the diagnosis of FTD was confirmed by hexamethylpropyleneamine oxime SPECT, were included in the study. The severity of the extrapyramidal symptoms was evaluated by the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). SPECT using (123)I-FP-CIT was done. A (region - occipital)/occipital ratio was calculated for the striatum, putamen and caudate nucleus. The results were compared with those of the 7 age-matched normal controls. The uptake of the radiotracer in the right and left striatum was reduced to 62% (p = 0.000) and 68% (p = 0.000), respectively, compared to controls. The motor UPDRS score of the patients with FTD showed a negative correlation to the uptake of the radiotracer. The presynaptic dopamine transporter in FTD is impaired, related to the severity of the extrapyramidal symptoms. Since an effective treatment for FTD is still to be established, there is a need for evaluating the efficacy of dopaminergic drugs.

Topics: Aged; Basal Ganglia Diseases; Brain; Corpus Striatum; Dementia; Dopamine; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Hypokinesia; Male; Muscle Rigidity; Tomography, Emission-Computed, Single-Photon; Tropanes

We performed [123I]FP-CIT/SPECT in 20 drug-naive Parkinson's disease (PD) patients, 10 with unilateral akinesia/rigidity at onset (arPD) and 10 with additional tremor-at-rest (tPD), to evaluate whether resting tremor at onset is associated with differences in striatal dopamine transporter binding. Patients of the two cohorts were matched for age, disease duration (<3 years) and severity of non-tremor motor symptoms; 31 healthy participants served as controls. Mean striatal dopamine transporter binding reduction in PD patients vs. controls was 42% for arPD and 50% for tPD; mean ipsilateral striatum and caudate nucleus uptake values were lower by 12 and 24%, respectively, in tPD than arPD. We conclude that widespread degeneration of the nigrostriatal dopaminergic pathway might be necessary for the development of parkinsonian tremor-at-rest.

Topics: Aged; Corpus Striatum; Female; Humans; Image Processing, Computer-Assisted; Iodine Radioisotopes; Male; Middle Aged; Muscle Rigidity; Parkinson Disease; Tomography, Emission-Computed, Single-Photon; Tremor; Tropanes