I was intrigued by the findings of Piccini et al1 in the February 1995 issue of the Archives that the frequency and extent of periventricular hyperintensities on magnetic resonance imaging is significantly higher in patients with Parkinson's disease (PD) than in healthy subjects, and that among the group with PD, patients with periventricular hyperintensities had significantly shorter disease duration but greater disease severity, particularly for postural instability and gait difficulty. One possible explanation that springs to mind is selection bias. We are not told how the "healthy" control subjects were selected for magnetic resonance imaging. More importantly, we do not know what proportion of the authors' patients with PD had magnetic resonance imaging scans over the 3-year study period. Many specialists in PD, including myself, tend only to perform brain imaging when there are atypical features (red flags) such as early and prominent postural instability and gait abnormality and
Quinn NP. Are Patients With Parkinson's Disease More Likely to Have Periventricular Hyperintensities Develop? Arch Neurol. 1996;53(3):211. doi:10.1001/archneur.1996.00550030013001
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