Should every person with suspected Parkinson’s get an MRI? For decades, neurologists have relied on history and examination as the gold standard for diagnosing Parkinson’s disease. Routine MRI scans have not been recommended for people with a classic presentation. However, more and more cases have been emerging and Maas, Bloem and colleagues have challenged us to 'rethink' a potentially outdated approach.
Key Points:
- The authors remind us that a careful history and neurological examination remain essential for diagnosing Parkinson’s disease.
- MRI can occasionally uncover a treatable mimic.
- The authors shared two cases that looked like classical Parkinson’s, however MRI revealed other causes: one person had a brain tumor, another had familial brain calcifications.
- The absence of clear non-motor symptoms may be more concerning than the author’s originally thought and they therefore argue that we should LOWER THE THRESHOLD for brain imaging.
My take: Maybe we should order a MRI for every person w/ Parkinson’s and/or a suspected neurodegenerative disease? David Vaillancourt and his multi-center PSG/NIH study has also recently shown that a 6 minute MRI sequence can be useful to separate PD from PSP and from MSA. Here are 5 points that resonated w/ me about this particular study. 1- Expert evaluation remains the backbone of a Parkinson’s diagnosis. 2- An MRI is not always ordered, but sometimes it can reveal a different and treatable condition. 3- If there are no typical non-motor symptoms like loss of smell, constipation, or dream enactment, doctors may actually need to be more cautious. 4- Getting one MRI early in the process may prevent delays in the right diagnosis and treatment. 5- Ongoing research is shaping how we use imaging to better care for people with suspected Parkinson’s disease. Does your Parkinson's plan
pdplan.org account for other diagnoses?
pn.bmj.com/content/early/202…
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