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Neuroradiology

E1267. Imaging of Movement Disorders

Devgun P,  Mittal V,  Samardzic D,  Kanekar S. Penn State Hershey Medical Center, Hershey, PA

Address correspondence to P. Devgun (puneetdevgun@gmail.com)

Background Information: The request for movement disorders is commonly encountered in a neuroimaging practice. The clinical presentation of movement disorders is complex, often variable, and sometimes even bizarre. Therefore, establishing the correct diagnosis can be challenging, even in the hands of experienced movement disorder specialists. Movement disorders can be either primary or secondary due to underlying CNS disease or a primary movement disorder. Imaging of this condition has significantly improved with the advent of molecular and cellular imaging, especially with diffusion-tensor imaging (DTI), MR spectroscopy, functional MRI (fMRI), and PET SPECT, especially DaTscan (GE Healthcare). Diagnosis of this condition is by detailed clinical examination, observation of the movement, and correlation with imaging findings. Retrospective review of the imaging studies of 213 patients with clinical diagnosis of movement disorders forms the basis of this exhibit. All patients underwent brain MRI. Twenty percent of patients underwent DTI and MR spectroscopy, 10 patients underwent fMRI, and 24 patients underwent DaTscan. For the data analysis and for the purposes of this exhibit, we used the Fahn, Marsden, and Jankovic classification of movement disorders: hypokinesia (decreased amplitude of movement) and hyperkinesias (excessive movements). Common disorders seen causing hypokinesia include Parkinson disease and Parkinson syndrome (diffuse Lewy body disease, multiple systems atrophy, progressive supranuclear palsy, corticobasal degeneration, vascular parkinsonism, posttraumatic parkinsonism, and secondary [toxin, medication, metabolic]). Hyperkinesia includes tremors, chorea, dystonia, myoclonus, ataxia and dysmetria, stereotypies and tics, akathisia, myokymia and synkinesias, restless legs, and periodic hypnogogic movements.

Educational Goals/Teaching Points: We describe the normal basal ganglia functional anatomy responsible for normal movement coordination, illustrate with examples the roles of structural and molecular neuroimaging in diagnosis of patients with movement disorders, and discuss the role of deep brain simulation in the treatment of movement disorders.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Movement disorders can be either primary or secondary due to underlying CNS disease or a primary movement disorder. Imaging of this condition has significantly improved with the advent of molecular and cellular imaging, especially with DTI, MR spectroscopy, fMRI, and PET SPECT, particularly with DaTscan. Diagnosis of this condition is by detailed clinical examination, observation of the movement, and correlation with imaging findings.

Conclusion: With the advent of molecular and cellular brain imaging, it is possible to show associated imaging changes in many of movement disorders. This exhibit will introduce viewers to the basic functional anatomy and imaging appearance of the various movement disorders. This exhibit is a core learning tool for imaging of movement disorders.