PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage
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概要
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Objective Because it is often difficult to precisely diagnose and distinguish progressive supranuclear palsy (PSP) from corticobasal degeneration (CBD), multiple system atrophy-parkinsonism (MSA-P) and Parkinsons disease (PD) at the onset of the disease, we compared the patients and clarified the features of these diseases. Methods We compared 77 PSP, 26 CBD, 26 MSA-P and 166 PD patients from clinical and imaging points of view including cerebral blood flow (CBF) in the frontal eye field. Results The clinical characteristics of PSP were supranuclear gaze disturbance, optokinetic nystagmus (OKN) impairment and falls at the first visit. On head MRI, midbrain tegmentum atrophy was much more frequently detected in PSP than in all of the other groups. Heart-to-mediastinum average count ratio (H/M) in iodine-123 meta-iodobenzyl guanidine (123I-MIBG) myocardial scintigraphy was not decreased in PSP, CBD, MSA-P and PD-Yahr 1 (-1), but patients of PD-2, 3, 4 and 5 showed a significant decrease compared with the PSP group. The CBF in the left frontal eye field of PD-3 group and that in right frontal eye field of PD-3 and PD-4 groups were lower than that of PSP group, although other groups showed a tendency without a significant decrease compared with PSP group. Conclusion PSP is distinguishable from CBD, MSA-P and PD even at the early stage with extra-ocular movement (EOM) disturbance, falls, atrophy of the midbrain tegmentum, and H/M in 123I-MIBG myocardial scintigraphy, and the reduction of CBF in area 8 could serve as a supplemental diagnostic method for distinguishing PSP from PD-3 or PD-4.
著者
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Sato Shuhei
Department Of Obstetrics And Gynecology Hirosaki University School Of Medicine
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Ikeda Yoshio
Department of Cardiology, Tachikawa General Hospital
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Kurata Tomoko
Department Of Anesthesiology Mie University School Of Medicine
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Abe Koji
Department Of Applied Chemistry Graduate School Of Engineering Tohoku University
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Manabe Yasuhiro
Department Of Neurology Graduate School Of Medicine And Dentistry Okayama Univeristy
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Ohta Yasuyuki
Department of Electrical Engineering, Faculty of Engineering, Nagaoka University of Technology, 1603-1 Kamitomioka, Nagaoka, Niigata 940-2188, Japan
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Deguchi Shoko
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Deguchi Kentaro
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Morimoto Nobutoshi
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Kurata Tomoko
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Kametaka Satsuki
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Takao Yoshiki
Department of Neurology, Kurashiki Heisei Hospital, Japan
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Ohta Taisei
Department of Neurology, Ota Memorial Hospital, Japan
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Sato Shuhei
Department of Radiology, Okayama University Graduate School of Medicine and Dentistry, Japan
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Ohta Yasuyuki
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan
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