title: PSP as distinguished from CBD, MSA-P and PD by clinical and imaging differences at an early stage.
abstract: OBJECTIVE
  Because it is often difficult to precisely diagnose and distinguish progressive supranuclear palsy (PSP) from corticobasal degeneration (CBD), multiple system atrophy-parkinsonism (MSA-P) and Parkinson's disease (PD) at the onset of the disease, we compared the patients and clarified the features of these diseases.
  
  
  METHODS
  We compared 77 PSP, 26 CBD, 26 MSA-P and 166 PD patients from clinical and imaging points of view including cerebral blood flow (CBF) in the frontal eye field.
  
  
  RESULTS
  The clinical characteristics of PSP were supranuclear gaze disturbance, optokinetic nystagmus (OKN) impairment and falls at the first visit. On head MRI, midbrain tegmentum atrophy was much more frequently detected in PSP than in all of the other groups. Heart-to-mediastinum average count ratio (H/M) in iodine-123 meta-iodobenzyl guanidine ((123)I-MIBG) myocardial scintigraphy was not decreased in PSP, CBD, MSA-P and PD-Yahr 1 (-1), but patients of PD-2, 3, 4 and 5 showed a significant decrease compared with the PSP group. The CBF in the left frontal eye field of PD-3 group and that in right frontal eye field of PD-3 and PD-4 groups were lower than that of PSP group, although other groups showed a tendency without a significant decrease compared with PSP group.
  
  
  CONCLUSIONS
  PSP is distinguishable from CBD, MSA-P and PD even at the early stage with extra-ocular movement (EOM) disturbance, falls, atrophy of the midbrain tegmentum, and H/M in (123)I-MIBG myocardial scintigraphy, and the reduction of CBF in area 8 could serve as a supplemental diagnostic method for distinguishing PSP from PD-3 or PD-4.
authors.affiliation: Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kurata
authors.forename: Satsuki
authors.initials: S
authors.lastname: Kametaka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ohta
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Morimoto
authors.forename: Shoko
authors.initials: S
authors.lastname: Deguchi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Deguchi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takao
authors.forename: Taisei
authors.initials: T
authors.lastname: Ohta
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Manabe
authors.forename: Shuhei
authors.initials: S
authors.lastname: Sato
authors.forename: Koji
authors.initials: K
authors.lastname: Abe
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000473:pathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology; D002560:Cerebrovascular Circulation; D003545:Cysteine / Q000031:analogs & derivatives; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019636:Neurodegenerative Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015609:Organotechnetium Compounds; D010300:Parkinson Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019275:Radiopharmaceuticals; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; C059659:technetium Tc 99m bicisate; D003545:Cysteine