Table 2.
MRI findings for differential diagnosis in symptomatic parkinsonism
| Entity | Typical MRI findings (may vary) |
|---|---|
| Vascular parkinsonism | Lacunar infarctions in the basal ganglia, frontal lobe infarctions, subcortical microangiopathic lesions with diffuse periventicular signal alterations |
| Normal pressure hydrocephalus | Enlargement of lateral cerebral ventricles, ballooning of anterior horn of lateral ventricle, periventricular T2 signal alterations |
| Toxic-induced parkinsonism | |
| Manganese | Hyperintensities in the globus pallidus, increasing signals in T1-weighted sequences in the striatum and SN |
| Ephedron (methcathinone) | Increased bilateral and symmetric T1-signal intensity in the globus pallidus and hyperintensities in the SN, no signal abnormalities on T2-weighted images |
| Carbon monoxide | Transient bilateral symmetric lesions in the globus pallidus with hyperintensities in T2-weighted images |
| Cyanide | Symmetric hyperintense signal changes in the globus pallidus, putamen, caudate nucleus, and white matter areas in T2-weighted images and FLAIR sequences, lesions in the basal ganglia displaying T1 signal increase with contrast enhancement |
| Methanol | T2 signal increase and T1 signal decrease in the area of the putamen |
| Huntington’s disease (Westphal variant) | Progressive bilateral atrophy of the striatum and caudate nucleus with enlarged anterior horn of lateral ventricle: in the later course widespread atrophy throughout the cortex; |
| Wilson’s disease | Atrophy of the midbrain, brain stem, and cerebellum; marked T2 hypointensity in the globus pallidus, symmetric T2 hyperintensity in the striatum, lateral thalamus, white matter, and dorsal brain stem; “face of the giant panda”: T2-weighted axial MRI with normal signal at the red nuclei (eyes) and lateral aspects of the SN (ears) with signal increase at the tegmentum and hypointense superior colliculi |
| Neurodegeneration with iron accumulation (NBIA) | |
| Panthothenate kinase-associated neurodegeneration (PKAN) | Decreased signal in T2-weighted sequences in the globus pallidus, putamen, caudate nucleus, and thalamus; „eye of the tiger“ sign: high signal in the center of the globus pallidus and T2 hypointensity of the surrounding area |
| Aceruloplasminaemia and neuroferritinopathy | T2 hypointensity in the globus pallidus, SN, striatum, thalamus, and dentate nucleus |
| Cerebral masses | Characteristic structural imaging according to the CNS tumours’ entity |
| Multiple sclerosis | T1‐weighted hypointense lesions (“black holes”) and hyperintensities in T2-weighted sequences in the SN and basal ganglia |