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Differentiation of Parkinson’s disease and atypical parkinsonian syndromes by transcranial ultrasound
  1. S Behnke1,
  2. D Berg2,
  3. M Naumann3,
  4. G Becker1,3
  1. 1Department of Neurology, University of Homburg, Saar, Germany
  2. 2Hertie Institute for Clinical Brain Research and Institute for Medical Genetics, University of Tuebingen, Germany
  3. 3Department of Neurology, University of Würzburg, Germany
  1. Correspondence to:
 Dr S Behnke
 Department of Neurology, University of the Saarland, Gebäude 9066421 Homburg/Saar, Germany;


Neuroimaging is known to complement clinical findings in the diagnostic work up of parkinsonian syndromes. Recently, transcranial ultrasound was reported to have a high diagnostic yield in differentiating idiopathic Parkinson’s disease (IPD) from atypical parkinsonian syndromes. This report summarises the sonographic findings of 102 patients with IPD, 34 patients with multiple system atrophy, and 21 patients with progressive supranuclear palsy. Increased echogenicity of the substantia nigra is predictive for IPD whereas a low echogenic substantia nigra, particularly when combined with a hyperechogenic lentiform nucleus, strongly suggests an atypical Parkinsonian syndrome. The underlying causes for the differential echo pattern of the substantia nigra remain unknown.

  • IPD, idiopathic Parkinson’s disease
  • MSA-P, parkinsonian variant of multiple system atrophy
  • PSP, progressive supranuclear palsy
  • SN, substantia nigra
  • TCS, transcranial sonography
  • atypical parkinsonian syndromes
  • neuroimaging
  • transcranial ultrasound

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  • This study was supported by grants from the Kompetenznetzwerk Parkinson, Germany, and the Siemens AG.

  • Competing interests: none declared