Correlation Between Clinical and CT Findings in Parkinson’s Syndrome

Abstract

The common patho-anatomic substrate of the different forms of Parkin-son’s syndrome consists of damaged cells of the substantia, nigra containing melanin. This degeneration of the dopaminergic neurons of the nigro striatal system leads to striatal dopamine-deficiency syndrome, in which cases the substitution of L-Dopa brought about the familiar positive change in the standard treatment of Parkinson’s syndrome with medicaments. It became apparent that in patients with parkinsonism who were examined pathoanatomically, but in particular by pneumoencephalography, changes in cerebralatrophy, apart from the specific nigra lesions, could be clearly defined. They can be defined in isolated corticalatrophy, isolated enlargement of the ventricles of the brain, or in a combinated hydrocephalus internus and externus. The CT permits an assessment of the frequency and the characteristics of these changes in an unselected group of patients with Parkinson’s disease. At the same time, it clarifies the advanced clinical report, without submitting the patients, who are for the most part elderly, to the strains and hazards of examination in the out patients department. The question of the significance of cerebro-organic changes in the symptomatology of Parkinson’s syndrome has become more urgent during the many years of our clinical and test psychologic follow-up studies. It is important forthe necessity of long-term theraphy with medicaments and alterations ofthe Parkinson etiology. Due to the decrease of cases postcencephalitis, the so-called idiopathetic Parkinsonism has nowadays become more prominent. At the same time, the age of onset has shifted to the second half of life. The age of incidence was in 1930, 31 years, in 1940, 45 years, and at the present time the syndrome manifests itself generally at the age of 60. In our own 221 cases, who were examined systematically and without bias, we found the average age of manifestation to be 63.4 years. By cross-classification of age and sex,female were found to be decidedly predominant in the older age groups. Our CT investagation demonstrated a significant predominance of isolated cortical atrophy in women. The statistical analysis of clinical data shows that from the 190 symptoms which we systematically observed per patient, no less than 47 of these exhibited significant sexual differences. The differences are found in particular in the subjective complaints and the psychopathologic equivalence, i.e., their test psychologic correlation, but not the specific nuerologic symptoms of akinesia, rigidity, and tremor. It has already been mentioned that since 1970 our group examined all patients unselectively with standardized methods and that after drug theraphy they were also submitted to extensive control investigation at regular intervals. Since the CT was first available to us in 1974, only a proportions of our patients were first examined with this new proceedure at the beginning of treatment. The majority of patients were first examined after varios long-term L-Dopa therapy and n some cases following stereotactic surgery. Further dicussion of the CT clinical correlation will be based of a sample of 58 cases whereby cmplete clinical examination and CT were performed before the beginning of treatment. In this way the significance of cerebral changes determined by the CT can be best assessed for the tota picture. The CT results were comprehensively distributed as follows: 6 cases (10%) were completely normal, 24 cases (41%) were at the border line, i.e., slightly pathologic, 23 cases (40%) were moderate, and 5 cases (9%) were severely pathologic.