Structural imaging in the differential diagnosis of parkinsonian syndromes

Magnetic resonance imaging is a useful tool in the differentiation of atypical parkinsonian syndromes from idiopathic Parkinson's disease. Specific abnormalities that point towards the diagnosis of an atypical parkinsonion disorder ore putaminal and infratentorial abnormalities in multiple system atrophy, midbrain, temporal or frontal lobe, pailidal or rubral abnormalities in progressive supranuclear palsy and asymmetrical cortical atrophy in corticobasal degeneration. Proton-spectroscopy con reveal neuronal loss in the lentiform nucleus in atypical parkinsonian disorders, which is not seen in idiopathic Parkinson's disease. Bath methods con facilitate early diagnosis of these atypical parkinsonian disorders. They should, however, always be interpreted in a clinical setting, as not ail patients with atypical parkinsonian disorders may show these specific abnormalities.