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PET-CT imaging in a patient with progressive supranuclear palsy.

A 67-year-old woman presented with falls, cognitive impairment, mild upgaze palsy and parkinsonism for 3 years. A MRI was unremarkable. A PET-CT with fluorodeoxyglucose (FDG) disclosed reduced metabolism in thalami, midbrain and frontal cortex (Figure 1), suggesting progressive supranuclear palsy (PSP). Posterior MRI showed typical features observed in PSP (Figure 2). PSP is a neurodegenerative disease which affects brainstem and basal ganglia1. Early differentiation between PSP and other atypical parkinsonism is a challenge1. MRI abnormalities in PSP usually appear in advanced stages2. In PSP, PET-CT involves upper brainstem, caudate nuclei, insula cortices and frontal cortex3,4. Functional imaging, such as PET-CT, may be relevant in early differentiation between Parkinson’s disease and atypical parkinsonism4.