III Meeting delle Neuroscienze Toscane: Disordini del Movimento e Parkinsonismo
Meeting held in Viareggio to discuss Parkinsonism, Hydrocephalus, clinical pitfalls, and radiological criteria. Experts present research on pathogenesis and overlap with neurodegenerative Parkinsonisms.
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III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 5-6-7 APRILE 2019 COMUNICAZIONI ORALI: DISORDINIDEL MOVIMENTO PARKINSONISMO ed IDROCEFALO NORMOTESO: CALL FOR AWARENESS CLAUDIA DEL GAMBA1, ANTONINO BRUNO1, DANIELA FROSINI1, DUCCIO VOLTERRANI2, GIANMICHELE MIGALEDDU3, NICOLA BENEDETTO4, PAOLO PERRINI4, MIRCO COSOTTINI3, UBALDO BONUCCELLI1, ROBERTO CERAVOLO1 1 DIPARTIMENTO DI MEDICINA CLINICA E SPERIMENTALE, U.O. NEUROLOGIA, UNIVERSITA DI PISA 2 DIPARTIMENTO DI RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA, U.O. MEDICINA NUCLEARE, UNIVERSITA DI PISA 3 DIPARTIMENTO DI RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA, U.O. RADIODIAGNOSTICA, UNIVERSITA DI PISA 4 DIPARTIMENTO DI PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL AREA CRITICA, U.O. NEUROCHIRURGIA, AZIENDA OSPEDALIERO-UNIVERSITARIA PISANA, PISA, ITALIA
BACKGROUND CLINICAL PITFALLS NO CLINIC FEATURE IS SPECIFIC DIAGNOSTIC PITFALLS CLINICAL CRITERIA HAKIM TRIAD HIGHER LEVEL GAIT DISORDER (Striatum-frontal circuit dysfunction) URINARY INCONNTINENCE DEMENTIA EXTRAPYRAMIDAL SIGNS DIAGNOSIS IS CONFIRMED BY RESPONSE TO THERAPY Espay et al, Annals of Neurology 2017 Chronic Hydrocephalus 0 DIAGNOSIS MUST EXCLUDE ANY OTHER CONDITION THAT MAY CONTRIBUTE TO THE CLINICAL PICTURE RADIOLOGICAL CRITERIA ventriculomegaly, DESH criterion, narrow callosal angle, periventricular white matter changes, csf flow void - PERIVENTRICULAR HYPERINTENSITY (MICROATHEROMATOUS VASCULOPATHY, AMYLOID ANGIOPATHY in AD) RADIOLOGICAL PITFALLS NO IMAGING FEATURE IS SPECIFIC - IDIOPATHIC, AQUEDUCTAL STENOSIS, LOVA NO SPECIFIC CSF MARKERS NO SPECIFIC PATHOLOGICAL FEATURE ventriculomegaly, fibrous thickening of leptomeninges, ependymal lining gaps, ischemic lesions AD, PSP, DLB III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
BACKGROUND III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
OBJECTIVE TOEXAMINEPATIENTSWITHINPH ANDEXTRAPYRAMIDALSIGNSTOSHEDALIGHT ONTHEIRPATHOGENESIS TOUNDERSTANDWHENTHEREISANOVERLAPWITHNEURODEGENERATIVE PARKINSONISMS HOWITMAYAFFECTTHESURGICALOUTCOME III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
MATERIAL and METHODS PATIENTSWITHCLINICALHINTSOFINPH ANDEXTRAPYRAMIDALSIGNS t0 t1 (6 m), t2 (12m) t3 (18m) CLINICAL EVALUATION: 10MWT, MDS-UPDRS III; MMSE CHRONIC TRIALWITH LEVODOPA - - THEORGANIZATIONOFTHESUBSTANTIANIGRA TOLOOKATRADIOLOGICALCRITERIAOFINPH TOVISUALIZEONIRON-SENSITIVESEQUENCES 3T MRI BRAIN SCAN t0 t2 123I-FP-CIT SPECT (DATSCAN) VENTRICULOPERITONEAL SHUNT III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
RESULTS 3 PATIENTSWITHGAITABNORMALITIES, URINARYURGENCY +/- MILDCOGNITIVEIMPAIRMENT + ASYMMETRICAKINETIC-RIGIDPARKINONISM Pt-1 65-yo lady Pt-2 72-yo lady Pt-3 65-yo man 10MWT 34 steps, 18 s >40 steps, >30 s 16 steps, 9 s MDS-UPDRS III 26, L > R parkinsonism 48, R > L parkinsonism 36, R > L parkinsonism MMSE 26.2/30 17.7/30 27.9/30 CHRONIC TRIALWITH LEVODOPAUNSUCCESSFULINALLOFTHEM III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
RESULTS PT-1 PT-3 - ABNORMAL DATSCAN - PRESERVATIONOF 3-LAYERSORGANIZATIONOF SUBSTANTIA NIGRA - ABNORMAL DATSCAN - LOSSOF 3-LAYERSORGANIZATIONOF SUBSTANTIA NIGRA t0 18-months f-up t0 18-months f-up 10MWT 16 steps, 9 s 15 steps, 9 s 10MWT 34 steps, 18 s 18 steps, 9.5 s MDS-UPDRS III 36 45 MDS-UPDRS III 26 17 MMSE 27,9/30 28,4/30 MMSE 26,2/30 30/30 Urinary fx incontinence continence Urinary fx incontinence continence t0? + 12m t0 + 12m III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
CONCLUSIONS ANABNORMAL DATSCAN MAYNOTNECESSARILYREVEALANOVERLAPBETWEENINPH AND NEURODEGENERATIVEPARKINSONISMS, SINCEIN 2 OUTOFOUR 3 CASESTHE SUBSTANTIA NIGRAAPPEAREDINTACTAT 3T MRI EXTRAPYRAMIDALSIGNSANDABNORMAL DATSCAN INTHESE 2 CASES, MAYBEDUETOA PRESSUREEFFECTONPERIVENTRICULARSTRUCTURESINCLUDINGDIENCEPHALONAND MIDBRAIN. THEINCREASEIN DAT AVAILABILITYPOST VPS, SUGGESTSASECONDARYANDPARTLY REVERSIBLEDAMAGETOTHENIGROSTRIATALPATHWAYCONSISTENTWITHAREMARKABLE CLINICALIMPROVEMENT. CONVERSELY, WHENTHEREISANUNDERLYINGNEURODEGENERATIVEPARKINSONISMTHETRACER UPTAKEANDTHECLINICALPICTURESAREDOOMEDTODETERIORATE III MEETING DELLE NEUROSCIENZE TOSCANE VIAREGGIO, 7 APRILE 2019
