Higher prevalence of idiopathic normal pressure hydrocephalus‐like MRI features in progressive supranuclear palsy: An imaging reminder of atypical parkinsonism

• Published in: Brain and behavior Vol. 13; no. 2; pp. e2884 - n/a
• Main Authors: Fu, Mu‐Hui, Huang, Chih‐Cheng, Wu, Kay L. H., Chen, Ying‐Fa, Kung, Yu‐Chih, Lee, Cheng‐Chang, Liu, Jia‐Shou, Lan, Min‐Yu, Chang, Yung‐Yee
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-02-2023; John Wiley and Sons Inc; Wiley
• Subjects: Alzheimer's disease; atypical parkinsonism; Brain diseases; Dopamine; Gait; Humans; Hydrocephalus; Hydrocephalus, Normal Pressure - diagnostic imaging; idiopathic normal pressure hydrocephalus; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Multiple System Atrophy - diagnostic imaging; Neurological disorders; Original; Parkinson Disease - complications; Parkinson's disease; Parkinsonian Disorders - complications; Parkinsonian Disorders - diagnostic imaging; Prevalence; progressive supranuclear palsy; Software; Supranuclear Palsy, Progressive - complications; Parkinson's disease; atypical parkinsonism; idiopathic normal pressure hydrocephalus; progressive supranuclear palsy
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.2884

Objectives
The classic triad of idiopathic normal pressure hydrocephalus (NPH) encompass gait disturbance, cognitive impairment, and urinary incontinence. These symptoms overlap with parkinsonism but with distinct treatment. Lacking applicable differentiation also hampers the prediction to therapeutic response. Here, we try to clarify this issue among different Parkinsonian syndromes and propose some innovative thinking while approaching a patient with parkinsonism and hydrocephalus concomitantly.
Methods
Twenty‐four patients with clinical probable multiple system atrophy (MSA), 34 with probable progressive supranuclear palsy (PSP), and 58 with sex‐ and age‐matched Parkinson's disease (PD) were enrolled. Evans’ index (EI), callosal angle (CA), antero‐posterior (AP) diameter of the midbrain, length of the midbrain tegmentum diameter (MBTegm), and disproportionately enlarged subarachnoid space hydrocephalus (DESH) were evaluated using the conventional MRI. Logistic regression was applied to identify the independent variables in hydrocephalus.
Results
Patients with PSP had higher mean EI than those with MSA and PD. Around 38.2% of patients with PSP had accompanied hydrocephalus (EI > 0.3). Parkinsonism subtypes (PD, MSA, or PSP), AP diameter of the midbrain, and MBTegm were significantly different among patients with and without hydrocephalus. After regression analysis, parkinsonism subtype stood out to be the most key risk factor of hydrocephalus. The comparison between patients with PSP with and without hydrocephalus did not disclose specific clinical characteristics or risk factors.
Conclusions
This study demonstrates that the presence of NPH‐like MRI features is much higher in PSP patients, and this tendency is decided upon the determination of parkinsonism subtype. Sharing pathophysiological characteristics in these two diseases is implied. More diagnostic tools are needed to better differentiate the two diseases and decide the treatment. To closely observe hydrocephalic parkinsonism patients and well inform the possible limited shunting benefits if PSP core features appear, will be more pivotal and practical at present clinical practice.