Objective: To investigate the nigrostriatal pathway in iNPH patients with clinical parkinsonism, employing dopaminergic transporter (DAT) and nigrosome imaging.

Background: Patients with idiopathic Normal Pressure Hydrocephalus (iNPH) may exhibit parkinsonism, but it is uncertain whether the parkinsonian features are inherent to the clinical syndrome of iNPH or result from a concurrent α-synucleinopathy.

Method: 20 iNPH patients with parkinsonism underwent dopaminergic imaging and 3T brain MRI. Additionally, 20 early Parkinson’s disease (PD) patients were included for DAT imaging comparison (Table 1).

Results: Among the iNPH patients with parkinsonism, none displayed nigrosome-1 loss, but over 40% showed reduced DAT uptake, exhibiting a distinct striatal dopamine loss pattern compared to PD (Figure 1). A negative correlation between left striatum DAT binding and motor severity was observed in iNPH.

Conclusion: Preserved nigrosome integrity suggests that parkinsonism in iNPH may arise from mechanical nigrostriatal pathway disruption. An abnormality on dopaminergic imaging should not be an exclusion criterion for shunting.

Figure 1

Table 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/imaging-the-nigrostriatal-pathway-in-patients-with-idiopathic-normal-pressure-hydrocephalus-and-parkinsonism/