帕金森叠加综合征的临床特点和鉴别要点

Clinical features and differentiations of Parkinson plus syndromes

目的探讨帕金森叠加综合征的临床特点、影像学特点及鉴别要点。方法选择自2004年1月至2009年4月间在天津医科大学总医院和天津市环湖医院神经内科锥体外系门诊就诊的原发性帕金森病（IPD）、多系统萎缩（MSA）、路易小体痴呆（DLB）、进行性核上性麻痹（PSP）和皮质基底节变性（CBD）患者共172例进行研究。对所有人组患者进行详细的病史问卷调查、体格检查和头部CT／MRI检查．对部分研究对象采用了脑^18F—FDG正电子发射断层扫描（PET）检查。结果（1）临床资料：各组患者主要临床特点除姿势异常外，差异均具有统计学意义（P〈0．05）。（2）头MRI检查：59例MSA患者接受头MRI检查，其中MRJ显示橄榄桥脑小脑萎缩48例（81．4％），T2加权像上的壳核低信号4例（6．8％），桥脑“十字征”30例（50．8％）。15例PSP患者中3例（20．0％）头MRI正中矢状位显示中脑特征性“蜂鸟样”改变。全部6例CBD患者头MRJ检查显示不对称的皮质萎缩（特别是额顶区），1例（16．7％）显示T2加权像上壳核低信号。（3）头部^18F-FDGPET扫描：各组患者示踪剂分布存在差异。结论（1）各帕金森叠加综合征均有其特异性临床特点，可藉此与原发性帕金森病相鉴别。（2）头部MRI、^18F—FDGPET检查可辅助诊断及鉴别IPD和帕金森叠加综合征。

Objective To explore the clinical and imaging features of Parkinson plus syndromes and its differentiation points. Methods Seventy-three patients with idiopathic Parkinson＇s disease （IPD）, 68 patients with multiple system atrophy （MSA）, 10 patients with dementia of Lewy bodies （DLB）, 15 patients with progressive supranuclear palsy （PSP） and 6 patients with corticobasal degegnration （CBD） were recruited between January, 2004 and April, 2009 from our hospitals. All patients were given detailed investigation, physical examination, mini-mental status examination and brain CT/MRI examination. Part of patients were performed 18F-FDG PE. Statistical analysis was performed with SPSS 11.0 software. Results Except for postural abnormity, all the other main clinical features differed significantly between each 2 groups （P〈0.05）. Brain MRI examination showed that Olivopontocerebellar atrophy was seen in 48 MSA patients （48/59, 81.4%）, putaminal hypointensities on T2-weighted images were seen in 4 MSA patients （4/59, 6.8%） and the ＂hot cross bun＂ signal in pons was seen in 30 MSA patients （30/59, 50.8%）; hummingbird-like changes were noted in midsagittal view of MRI in 3 PSP patients （3/15, 20.0%）; all 6 CBD patients presented asymmetric cortical atrophy, especially in the frontoparietal areas, and 1 also presented putaminal hypointensities on T2-weighted image. Brain 18F-FDG PET indicated that ~SF-FDG intake presented different distribution among groups. Conclusion Each atypical Parkinsonian syndrome has its specific clinical features which attribute to rule it out from either IPD or other Parkinson plus syndromes; brain MRI examination and 18F-PET scan can help to diagnose and differentiate Parkinson plus syndromes.