Objective: The diagnosis of Parkinson’s disease and parkinsonian syndromes remains clinically difficult, is based on clinical diagnostic criteria, MRI plays a major role in the differentiation between Parkinson’s disease and atypical parkinsonism. While atypical parkinsonism is characterized by relatively specific MRI signs, and to see the progression of parkinson’s disease. (1).

Background: Cerebral imaging occupies a place of choice in the positive and differential diagnosis of parkinsonian syndromes. Several tools are available to the clinician, whether magnetic resonance imaging (MRI) or functional imaging techniques including positron emission tomography (PET) and single photon emission tomography (SPECT).

We present the case of a group of patients who present an atypical parkinsonian syndrome, with clinical red flags for parkinson’s disease, in whom we compared the different radiological aspects with cerebral MRI, in order to make a clinico-radiological approach to this group of diseases and date the appearance of the radiological signs in relation to the clinical signs (1).

Method: Our study concerns a group of patients already followed at our level for atypical parkinsonian syndrome, whose initial MRI was normal in most of them at the very beginning of the disease; in whom a new brain MRI was requested 2 or even 3 years after the onset of symptoms and who showed radiological signs specific to each type of atypical parkinsonian syndrome. The clinical data are presented in the following table (table A).

Results: The different radiological aspects found in our patients are represented in table A.

Conclusion: Bain MRI has facilitated a better understanding of the processes of atypical parkinsonian syndromes, it can be normal at the beginning of the disease, hence the interest of repeating it later. (2).

References: (1) Lydia Chougar 1,2,3,4*, Nadia Piatigorskaia 1,2,3,4, Bertrand Degos 5,6, David Grabli 7,Stéphane Lehéricy1,2,3,4.The Role of Magnetic Resonance Imaging for the Diagnosis of Atypical Parkinsonism. Frontiers in Neurology,July 2020.

(2) Usman Saeed1 , Anthony E. Lang2,3 and Mario Masellis 1,2,4,5 *.Neuroimaging advances in Parkinson’s disease and atypical parkinsonian syndroms.Frontiers in Neurology,15 Octobre 2020.
(3) Schekeb Aludin, Lars-Patrick Andreas Schmill. MRI Signs of Parkinson’s Disease and Atypical Parkinsonism. Fortschr Röntgenstr | © 2021. Thieme.
(4) Ping Zhao a,⇑ , Benshu Zhang b , Shuo Gao c , Xin Li a.Clinical, MRI and 18F-FDG-PET/CT analysis of progressive supranuclear palsy. Journal of Clinical Neuroscience, 2020 Published by Elsevier Ltd.
(5) Gerard M. Saranza1 , Jennifer L. Whitwell2 , Gabor G. Kovacs1,3,4,5 and Anthony E. Lang* ,1,5.Corticobasal degeneration. International Review of Neurobiology, Volume 149.2019.
(6) MELISSA J. ARMSTRONG* AND NIKOLAUS MCFARLAND. Recognizing and treating atypical Parkinson disorders. Handbook of Clinical Neurology, Vol. 167 (3rd series) Geriatric Neurology.2019.
(7) Francois Kouda1,2,&, Saydou Ly1,2, Meriem Haloua1,2, Badreeddine Alami1,2 , Mustapha Maaroufi1,2, Meryem Boubbou1,2 , Youssef Lamrani1. Multiple system atrophy: about a case and literature review.PAMJ (Pan African medecical journals),10 March 2020.
(8) Beatrice Heim*, Florian Krismer*,1, Klaus Seppi*,†,1.Structural Imaging in Atypical Parkinsonism. International Review of Neurobiology, Volume 142.2018.
(9) A. B. Deutschlander € a,b,c , O. A. Rossb,c, D. W. Dicksonb and Z. K. Wszoleka.Atypical parkinsonian syndromes: a general neurologist’s perspective. European Journal of Neurology 2018, 25: 41–58.
(10) Beatrice Heim1 • Florian Krismer1 • Roberto De Marzi1 • Klaus Seppi1,2. Magnetic resonance imaging for the diagnosis of Parkinson’s disease. J Neural Transm,April 2017.
(11) Nikolaus R. McFarland, MD, PhD1 Christopher W. Hess, MD1.Recognizing Atypical Parkinsonisms: “Red Flags” and Therapeutic Approaches. Semin Neurol 2017;37:215–227. by Thieme Medical
(12) Keita Sakurai1 & Aya M Tokumaru1 & Keigo Shimoji 1 & Shigeo Murayama2 & Kazutomi Kanemaru2 & Satoru Morimoto2 & Ikuko Aiba3 & Motoo Nakagawa4 & Yoshiyuki Ozawa4 & Masashi Shimohira4 & Noriyuki Matsukawa5 & Yoshio Hashizume6 & Yuta Shibamoto4. Beyond the midbrain atrophy: wide spectrum of structural MRI finding in cases of pathologically proven progressive supranuclear palsy. Neuroradiology. 19 February 2017.
(13) Michał Sobańskia Anna Zacharzewska-Gondeka Marta Waliszewska-Prosółb Marek Jan Sąsiadeka Anna Zimnya Joanna Bladowskaa. A Review of Neuroimaging in Rare Neurodegenerative Diseases.. Dement Geriatr Cogn Disord 2020;49:544–556.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/atypical-parkinsonian-syndrome-with-evocative-brain-mri-imaging-about-seven-cases/