Lamotte, Guillaume

ABSTRACT Background Parkinson's disease with orthostatic hypotension (PD + OH) can be difficult to distinguish clinically from the parkinsonian form of multiple system atrophy (MSA‐P). Previous studies examined cardiac sympathetic neuroimaging to differentiate PD from MSA but without focusing specifically on PD + OH versus MSA‐P, which often is the relevant differential diagnostic issue. Objective To investigate the utility of cardiac sympathetic neuroimaging by 18 F‐dopamine positron emission tomographic (PET) scanning for separating PD + OH from MSA‐P. Methods Cardiac 18 F‐dopamine PET data were analyzed from 50 PD + OH and 68 MSA‐P patients evaluated at the NIH Clinical Center from 1990 to 2020. Noradrenergic deficiency was defined by interventricular septal 18 F‐dopamine‐derived radioactivity <6000 nCi‐kg/cc‐mCi in the 5′ frame with mid‐point 8′ after initiation of 3′ tracer injection. Results 18 F‐Dopamine PET separated the PD + OH from the MSA‐P group with a sensitivity of 92% and specificity of 96%. Conclusion Cardiac 18 F‐dopamine PET scanning efficiently distinguishes PD + OH from MSA‐P.

We report the case of a healthcare worker who presented with a large vessel acute ischemic stroke in setting of a mild SARS-CoV-2 infection and provide a review of the emerging literature on COVID-related stroke. A 43-year-old female presented with right-sided hemiparesis, aphasia and dysarthria. She had a nonproductive of cough for 1 week without fever, fatigue or dyspnea. A CT Head, CT angiography and CT perfusion imaging revealed a M1 segment occlusion of the left middle cerebral artery requiring transfer from a primary to a comprehensive stroke center. A nasopharyngeal swab confirmed SARS-CoV-2 infection prior to arrival at the accepting center. During the thrombectomy a 3 cm thrombus was removed. Thrombus was also evident in the 8 French short sheath during closure device placement so a hypercoagulable state was suspected. Stroke work-up revealed a glycosylated hemoglobin of 8.7%, elevation of inflammatory markers and an indeterminate level of lupus anticoagulant IgM. On discharge home, she had near complete neurological recovery. This case highlights suspected mechanisms of hypercoagulability in SARS-CoV-2 infection and the importance of optimizing stroke care systems during the COVID-19 pandemic.