Objective: To present an empirical observation regarding transcranial ultrasound in movement disorders and scalp sebum smear.

Background: Transcranial ultrasound (TUS) detects substantia nigra hyperechogenicity (SN+) in 80-85% patients with Parkinson’s disease (PD). This echofeature is also detected in the prodromal phase of the disease, and associated with characteristic non-motor symptoms. The link between seborrheic dermatitis (SD) and PD is well established, as a risk factor and a common non-motor feature of the disease.

Method: Prospective analysis of consecutive patients with movement disorders who underwent diagnostic TUS in clinical practice (4 months period). TUS was performed with an EsaoteMyLab25Gold system, in supine position, on an ultrasound bed covered with disposable paper (Unidix 0.58×1.52), lasting approximately 10 minutes. Presence of a scalp sebum smear at the end of the examination was registered dichotomously (see Figures for examples).

Results: Fifty-two patients (54% male), 72 (39-89) years old, with follow-up after TUS of 20 months (3-34) were included. SN+ was found in 34 (65%) and 16 (31%) had a positive smear (Figures 1-3). Final diagnosis at the end of follow-up was PD in 26 (50%), atypical parkinsonism (AP) in 9 (17%) and other diagnoses in 17 (33%). SN+ was associated with PD diagnosis (p:0.0078) and male sex (p: 0.04). Positive smear was associated with SN+ (p:0.0044) and male sex (p: 0.0003e-2), but not with final diagnosis. Multivariate analysis confirmed an association between SN+ and positive smear independent from sex (OR 11, IC95% 1.05-110).

Conclusion: A positive scalp sebum smear in TUS examination paper is an easily detectable sign, strongly associated with SN hyperechogenicity. The relationship of both SN+ and SD with prodromal and defined PD may explain this observation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-trace-of-substantia-nigra-hyperechogenicity-a-clinical-observation/