Magnetic resonance imaging in progressive supranuclear palsy and other parkinsonian disorders

  • M. Savoiardo
  • F. Girotti
  • L. Strada
  • E. Ciceri
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 42)


High field intensity MRI may demonstrate signal abnormalities consistent with deposits of iron or other paramagnetic substances in several extrapyramidal disorders. Hallervorden-Spatz disease was the only disorder widely known to have iron deposits in the pallidum, that are now easily demonstrated in vivo by MRI. However, lower field intensity MRI may also demonstrate characteristic findings.

In progressive supranuclear palsy, definite atrophy of the midbrain and of the region around the third ventricle is seen in slightly more than half of the cases. Minimal signal abnormalities are sometimes seen in the peri-aqueductal region, but MRI studies remain of little help in establishing the diagnosis of the disease.

Asymmetric atrophy in the parietal regions is seen in corticobasal degeneration, as expected from pathological studies. Minimal alterations may be seen in the substantia nigra in Parkinson’s disease.

The most interesting MRI findings are observed in multiple system atrophies. Variable abnormal signal intensities, depending on the field intensity, are visible in the putamen in striatonigral degeneration and in Shy-Drager syndrome; in this latter condition the abnormalities are due to its striatonigral degeneration component. Atrophy of the pons, middle cerebellar peduncles, and cerebellum, and signal abnormalities in a characteristic distribution are visible in olivopontocerebellar atrophy.

A combination of these posterior fossa abnormalities and putaminal alterations may confirm the involvement of the cerebellar and extrapyramidal systems in multiple system atrophies.


Multiple System Atrophy Magnetic Resonance Image Finding Progressive Supranuclear Palsy Progressive Supranuclear Palsy Corticobasal Degeneration 
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  1. Barr AN (1979) Progressive supranuclear palsy. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 49. North-Holland, Amsterdam, pp 233–256.Google Scholar
  2. Bentson JR, Keesey JC (1974) Pneumoencephalography of progressive supranuclear palsy. Radiology 113: 89–94.PubMedGoogle Scholar
  3. Borit A, Rubinstein LJ, Urich H (1975) The striatonigral degenerations: putaminal pigments and nosology. Brain 98: 101–112.PubMedCrossRefGoogle Scholar
  4. Braffman BH, Grossman RI, Goldberg HI, et al (1988) MR of Parkinson’s disease using spin-echo and gradient-echo sequences. AJNR 9: 1093–1099.Google Scholar
  5. Brown NT, Polinsky RJ, Di Chiro G, Pastakia B, Wener L, Simmons JT (1987) MRI in autonomic failure. J Neurol Neurosurg Psychiatry 50: 913–914.PubMedCrossRefGoogle Scholar
  6. Dexter DT, Carayon A, Javoy-Agid F, et al (1991) Alterations in the levels of iron, ferritin and other trace metals in Parkinson’s disease and other neurodegenerative diseases affecting the basal ganglia. Brain 114: 1953–1975.PubMedCrossRefGoogle Scholar
  7. Drayer BP, Burger P, Darwin R, Riederer S, Herfkens R, Johnson GA (1986a) Magnetic resonance imaging of brain iron. AJNR 7: 373–380.Google Scholar
  8. Drayer BP, Olanow W, Burger P, Johnson GA, Herfkens R, Riederer S (1986b) Parkinson plus syndrome: diagnosis using high field MR imaging of brain iron. Radiology 159: 493–498.PubMedGoogle Scholar
  9. Dooling EC, Schoene WC, Richardson EP Jr (1974) Hallervorden-Spatz syndrome. Arch Neurol 30: 70–83.PubMedCrossRefGoogle Scholar
  10. Duguid JR, De La Paz R, De Groot J (1986) Magnetic resonance imaging of the midbrain in Parkinson’s disease. Ann Neurol 20: 744–747.PubMedCrossRefGoogle Scholar
  11. Gibb RG, Luthert PJ, Marsden CD (1989) Corticobasal degeneration. Brain 112: 1171–1192.PubMedCrossRefGoogle Scholar
  12. Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT (1985) Intracranial hematomas: imaging by high-field MR. Radiology 157: 87–93.PubMedGoogle Scholar
  13. Masucci EF, Borts FT, Smirniotopoulos JG, Kurtzke JF, Schellinger D (1985) Thinsection CT of midbrain abnormalities in progressive supranuclear palsy. AJNR 6: 767–772.PubMedGoogle Scholar
  14. Oppenheimer DR (1984) Diseases of the basal ganglia, cerebellum and motor neurons. In: Hume Adams J, Corsellis JAN, Duchen LW (eds) Greenfield’s neuropathology, 4th edn. Wiley, New York, pp 699–747.Google Scholar
  15. Pastakia B, Polinsky R, Di Chiro G, Simmons JT, Brown R, Wener L (1986) Multiple system atrophy (Shy-Drager syndrome): MR imaging. Radiology 159: 499–502.PubMedGoogle Scholar
  16. Quinn N (1989) Multiple system atrophy — The nature of the beast. J Neurol Neurosurg Psychiatry 1989 [Special Suppl]: 78–89.CrossRefGoogle Scholar
  17. Rebeiz JJ, Kolodny EH, Richardson EP (1968) Corticodentatonigral degeneration with neuronal achromasia. Arch Neurol 18: 20–33.PubMedCrossRefGoogle Scholar
  18. Rutledge JN, Hilal SK, Silver AJ, Defendini R, Fahn S (1987) Study of movement disorders and brain iron by MR. AJNR 8: 397–411.Google Scholar
  19. Savoiardo M, Strada L, Girotti F, et al (1989) MR imaging in progressive supranuclear palsy and Shy-Drager syndrome. J Comput Assist Tomogr 13: 555–560.PubMedCrossRefGoogle Scholar
  20. Savoiardo M, Strada L, Girotti F, et al (1990) Olivopontocerebellar atrophy: MR diagnosis and relationship to multisystem atrophy. Radiology 174: 693–696.PubMedGoogle Scholar
  21. Savoiardo M, Halliday WC, Nardocci N, et al (1993) Hallervorden-Spatz disease: MR and pathological findings. AJNR 14: 155–162.PubMedGoogle Scholar
  22. Schonfeld SM, Golbe LI, Sage JI, Safer JN, Duvoisin RC (1987) Computed tomographic findings in progressive supranuclear palsy: correlation with clinical grade. Mov Disord 2: 263–278.PubMedCrossRefGoogle Scholar
  23. Sethi KD, Adams RJ, Loring DW, El Gammal T (1988) Hallervorden-Spatz syndrome; clinical and magnetic resonance imaging correlations. Ann Neurol 24: 692–694.PubMedCrossRefGoogle Scholar
  24. Rutledge JN, Schallert T, Hall S (1993) Magnetic resonance imaging in parkinsonisms. In: Narabayashi H, Nagatsu T, Yanagisawa N, Mizuno Y (eds) Advances in neurology, vol 80. Raven Press, New York, pp 529–534.Google Scholar

Copyright information

© Springer-Verlag Wien 1994

Authors and Affiliations

  • M. Savoiardo
    • 1
  • F. Girotti
    • 2
  • L. Strada
    • 1
  • E. Ciceri
    • 1
  1. 1.Department of NeuroradiologyIstituto Nazionale Neurologico “C. Besta”MilanoItaly
  2. 2.Department of NeurologyIstituto Nazionale Neurologico “C. Besta”MilanoItaly

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