MSA can be subdivided into three distinct clinical subtypes: MSA-P (striatonigral degeneration), in which extrapyramidal/parkinsonian features predominate, MSA-C (olivopontocerebellar atrophy), in which ataxia and cerebellar symptoms predominate, and less commonly, MSA-A (Shy-Drager syndrome), in which autonomic dysfunction predominates. The majority of cases of MSA exhibit Parkinsonian symptoms at some stage of the disease, with cerebellar ataxia, pyramidal signs, and dysautonomia (including urinary incontinence) frequently reported. The typical onset is 55 to 65 years of age with a mean disease duration of almost 6 years [30]. PSP, also known as Steele-Richardson-Olszewski syndrome, is the most common atypical Parkinsonism with a prevalence of around 5/100,000 [30]. Patients classically present in the sixth or seventh decade (mean age of onset at 63) with a lurching gait and axial dystonia, manifested as unexplained falls [30]. Ocular symptoms, including blurred vision and slow saccades, can be seen early in the disease; however, the classic finding of vertical supranuclear gaze palsy is usually only seen later in the course of the disease. Correctly diagnosing a Parkinsonian syndrome on clinical features alone can be quite challenging, and imaging remains an essential diagnostic tool in the evaluation of a patient presenting with Parkinsonian symptoms. CT Head CT is not the preferred imaging modality for the workup of Parkinsonian syndromes because of its limited soft- tissue characterization when compared with MRI. Nonetheless, CT imaging can effectively demonstrate the patterns of regional volume loss characteristic of MSA, CBD, or PSP, as described in the MRI section. CT findings are Movement Disorders and Neurodegenerative Diseases nonspecific for PD but can help to exclude focal or regional atrophy, underlying structural lesions, or vascular disease that might signal an alternative diagnosis. Contrast is typically not indicated.
Movement Disorders and Neurodegenerative Diseases. MSA can be subdivided into three distinct clinical subtypes: MSA-P (striatonigral degeneration), in which extrapyramidal/parkinsonian features predominate, MSA-C (olivopontocerebellar atrophy), in which ataxia and cerebellar symptoms predominate, and less commonly, MSA-A (Shy-Drager syndrome), in which autonomic dysfunction predominates. The majority of cases of MSA exhibit Parkinsonian symptoms at some stage of the disease, with cerebellar ataxia, pyramidal signs, and dysautonomia (including urinary incontinence) frequently reported. The typical onset is 55 to 65 years of age with a mean disease duration of almost 6 years [30]. PSP, also known as Steele-Richardson-Olszewski syndrome, is the most common atypical Parkinsonism with a prevalence of around 5/100,000 [30]. Patients classically present in the sixth or seventh decade (mean age of onset at 63) with a lurching gait and axial dystonia, manifested as unexplained falls [30]. Ocular symptoms, including blurred vision and slow saccades, can be seen early in the disease; however, the classic finding of vertical supranuclear gaze palsy is usually only seen later in the course of the disease. Correctly diagnosing a Parkinsonian syndrome on clinical features alone can be quite challenging, and imaging remains an essential diagnostic tool in the evaluation of a patient presenting with Parkinsonian symptoms. CT Head CT is not the preferred imaging modality for the workup of Parkinsonian syndromes because of its limited soft- tissue characterization when compared with MRI. Nonetheless, CT imaging can effectively demonstrate the patterns of regional volume loss characteristic of MSA, CBD, or PSP, as described in the MRI section. CT findings are Movement Disorders and Neurodegenerative Diseases nonspecific for PD but can help to exclude focal or regional atrophy, underlying structural lesions, or vascular disease that might signal an alternative diagnosis. Contrast is typically not indicated.