| خلاصه مقاله | Most patients (about 80–85%) diagnosed with
Parkinson’s disease have what is called primary
parkinsonism or idiopathic Parkinson’s disease
(meaning that the disease has no known cause).
This type tends to respond well to drugs that work
by increasing or substituting dopamine molecules
in the brain but at secondary parkinsonism type ,a
key difference is that patients do not respond well
to dopaminergic medications such as levodopa and
second type Includes drug-induced parkinsonism,
vascular parkinsonism, normal pressure
hydrocephalus (NSA), corticobasal degeneration
(CBD),progressive supranuclear palsy (PSP) and also
multiple system atrophy (MSA).
Progressive supranuclear palsy (PSP) is more common
forms of secondary parkinsonism. As with idiopathic
Parkinson’s disease, progressive supranuclear palsy
has a late age of onset, but the symptoms tend to
progress far more rapidly once they appear. However,
dementia tends to have a later onset as the disease
progresses.
Multiple system atrophy (MSA)results in symptoms
that are similar to idiopathic Parkinson’s disease, but
with a much faster progression.
Corticobasal degeneration (CBD) is the least common
of the atypical parkinsonisms and caused by a buildup of proteins called tau, which damage parts of the
brain.
In most cases the diagnosis of probable PD can
be made on clinical grounds, and no ancillary
investigations are needed, however, in early PD the full
triad of clinical symptoms and signs (bradykinesia,
tremor at rest and rigidity) may not yet be manifested
Substancia nigra is located at midbrain and composed
from pars compacta and retinacula. Pars compacta is
formed by dopaminergic neurons and located medial
to pars reticulata (between this part and red nucleus)
CT scans can show nonspecific atrophy with enlarged
ventricles and sulci and Conventional MRI at 1.5 T
with routine T2- and T1W imaging does not reveal
disease-specific abnormalities in PD and, particularly
in the early phases, the MRI appears normal and
Its main role is to exclude 1.subcortical vascular
pathology, 2.rare secondary causes of parkinsonism
(e.g., Wilson’s disease, NPH, or tumors, granulomas, or
calcification of basal ganglia), and 3.in discriminating
atypical parkinsonian syndromes.
T1 images may show mild hyperintensity of compact
and reticular parts of the substantia nigra and red
nuclei (due to iron accumulation) or may show loss
of normal slight hyperintensity in substantia nigra
due to loss of neuromelanin.
Loss of the normal swallow tail appearance of
susceptibility signal pattern in the substantia nigra
on axial imaging is perhaps the most promising
diagnostic sign and swallow tail sign describes the
normal axial imaging appearance of nigrosome-1
within the substantia nigra on high-resolution T2*/
SWI weighted MRI. |