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Transcranial duplex in the differential diagnosis of parkinsonian syndromes

A systematic review

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Abstract

Background

Transcranial duplex scanning (TCD) of the substantia nigra (SN) is increasingly used to diagnose Idiopathic Parkinson’s Disease (IPD). Up until now 70 diagnostic studies have been published, not only on investigation of the SN, but also of the lenticular nucleus (LN) and the Raphe nuclei (RN).

Method

We systematically reviewed all diagnostic TCD studies in parkinsonian patients up to June 2008.

Results

We found 35 eligible studies. Of the 1534 IPD patients investigated in the 35 studies 200 (13 %) had an inconclusive SN-TCD. An increased echo-intensity of the SN was seen in 1167 (87 %) of the 1334 IPD patients, 276 (12 %) of the 2340 healthy controls and in 41 (30 %) of the 138 patients with an atypical parkinsonian syndrome (APS). On the contrary, a pathological LNTCD was found more often in APS patients (79 %) than in IPD patients (23 %) and healthy controls (6 %). A decreased echo-intensity of the RN was found more often in depressed (46 %) than in non-depressed IPD patients (16 %).

Conclusions

SN-TCD accurately differentiates between patients with IPD and healthy controls, but not between patients with IPD and APS. LN-TCD is only moderate accurate to delineate IPD from APS, but combinations of SN- and LN-TCD may be more promising. RN-TCD has only marginal diagnostic accuracy in diagnosing depression in IPD and non-IPD patients. Before TCD can be implicated, more research is needed to standardize the TCD technique, to investigate the TCD in non-research settings and to determine the additional value of TCD compared with currently used clinical techniques like SPECT imaging.

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Abbreviations

APS:

Atypical Parkinsonian Syndromes

DIP:

Drug Induced Parkinsonism

ET:

Essential Tremor

IPD:

Idiopathic Parkinson’s Disease

LN:

Lenticular Nucleus

MSA:

Multiple System Atrophy

PET:

Positron Emission Tomography

PSP:

Progressive Supranuclear Palsy

RN:

Raphe Nuclei

SN:

Substantia Nigra

SPECT:

Single Photon Emission Computer Tomography

TCD:

Transcranial Duplex Scanning

VP:

Vascular Parkinsonism

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Authors and Affiliations

  1. Dept. of Neurology, University Hospital Maastricht, 5800, 6202 AZ, Maastricht, The Netherlands

    Annemarie M. M. Vlaar, Angela Bouwmans & Wim E. J. Weber MD, PhD

  2. Dept. of Clinical Neurophysiology, University Hospital Maastricht, Maastricht, The Netherlands

    Werner H. Mess MD, PhD

  3. Dept. of Clinical Neurophysiology, St. Antonius Hospital, Nieuwegein, The Netherlands

    Selma C. Tromp MD, PhD

Authors
  1. Annemarie M. M. Vlaar
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  2. Angela Bouwmans
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  3. Werner H. Mess MD, PhD
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  4. Selma C. Tromp MD, PhD
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  5. Wim E. J. Weber MD, PhD
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Correspondence to Annemarie M. M. Vlaar.

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Vlaar, A.M.M., Bouwmans, A., Mess, W.H. et al. Transcranial duplex in the differential diagnosis of parkinsonian syndromes. J Neurol 256, 530–538 (2009). https://doi.org/10.1007/s00415-009-0143-8

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  • DOI: https://doi.org/10.1007/s00415-009-0143-8

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