Neuroimaging Clinics of North America: Imaging of Movement Disorders. Suresh K. Mukherji (Consulting Editor). Tarek A. Yousry, and Andrew J. Lees (Guest Editors). Volume 20, Number 1, February 2010, Theclinics.com, pages 144, $293.00.
The February 2010 issue of Neuroimaging Clinics of North America “Imaging of Movement Disorders” guest edited by Drs. Yousry and Lees is a 144-page compilation of clinical, anatomic and imaging information related to movement disorders. There are 10 chapters, starting with a summary of the various classifications of movement abnormalities and what the implications are for each. An excellent and highly detailed chapter on the substantia nigra and subthalamic nucleus sets the stage for material which follows on both the imaging diagnosis and surgical interventions for these disorders. Review of normal and abnormal iron deposits in the brainstem and basal ganglia, the former dealing with differential deposits in the substantia nigra (SN) reticulata vs. substantia nigra compacta and their connections/pathways. Much of the detailed anatomy of the SN is beyond what is needed to offer imaging interpretations in these disorders, but for those interested, it contains a nice summary of the histological underpinnings of these diseases. While, clearly, the diagnosis Parkinson’s Disease does not depend on the MR demonstration of alterations of the substantia nigra compacta (and in reality whether one can do that on a routine basis), the descriptions serve as a baseline for the most common of movement disorders. The often elusive location of the subthalmic nuclei is well described and illustrated.
What is most important is to attempt to separate different disease with parkinsonian-like clinical findings and to rule out more overt structural abnormalities which result in movement disorders. This the book does in proper depth. Distinguishing characteristics of syndromes causing parkinson symptoms such as multisystem atrophy, (MSA) and progressive supranuclear palsy are shown and described; in fact the references and an extensive table detailing the literature/findings in diffusion weighted imaging and diffusion tensor imaging in atypical Parkinsonism serve as source material on this subject.
Subsequent chapters on PET and SPECT in extra pyramidal syndromes, vascular Parkinsonism, evaluation of tremor (many of which are primarily clinically based) are well written but probably of less value to the clinical neuroradiologist. A practical chapter on how neuroimaging can help in the diagnosis of movement disorders is particularly good because it presents different cases with clinical histories, the appropriate imaging, and a discussion of the movement disorder (Fragile x, Tremor ataxic Syndrome, neuro degeneration with brain iron accumulation — Hallervorden Spatz, neuroferinopathy, manganese poisoning, new variant CJD, multisystem atrophy, progressive supranuclear palsy, Wilson’s disease). Considerable clinical information accompanies each case, along with complete differential diagnoses and pathologic information.
The last chapter entitled “The Role of Imaging in the Surgical Treatment of Movement Disorders,” written by a neurological surgeon, describes those conditions where functional neurosurgery (FNS) can be employed. Here, following a historical review of FNS, a summary of implanted deep brain stimulation guided by MR imaging follows. Commissural points, subthalmic nucleus targeting for PD, and other potential structural sites for stimulation such as the globus pallidus interna, motor thalamus/zona incerta are shown. Of additional interest to the neuroradiologist is a short segment on safety issues involved with DBS and MR imaging.
This issue of the Clinics is highly recommended, particularly to those neuroradiologists who work in large centers where patients with movement disorders are evaluated and treated.
