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A retrospective analysis of clinicopathologic correlation was carried out using brain histology positive for Lewy body aggregates of alpha-synuclein as the standard for diagnosis. All clinically and pathologically diagnosed PD patient autopsies (n=39) during a period from August 2006 to February 2018 at the University of Toledo Medical Center (formally Medical University of Ohio) were included and major diagnostic discrepancies were analyzed. The “misdiagnosed” patients were compared to confirmed Parkinson’s patients with similar distributions of age, race and sex.  Comparators included gross and microscopic pathology, symptomatology, medication regiment and response.

10(25.6%) of autopsies were negative for Lewy body aggregates of alpha-synuclein. Of the patients that were misdiagnosed (positive clinical diagnosis but negative histologic diagnosis) 6 had a pathologic diagnosis of vascular infarct and ischemic changes, 2 had an alternative diagnosis of multiple system atrophy, 1 had a confirmed diagnosis of Hemochromatosis, and 1 had a confirmed diagnosis of Meningioma. 9/10 misdiagnosed vs 0/10 confirmed patients exhibited well pigmented substantia nigra on gross examination. Only 4/10 of misdiagnosed vs 10/10 of confirmed patients exhibited consistent resting tremor during examination from a movement disorder specialist. Comparison of response to carbidopa/levodopa showed that 4/10 of misdiagnosed patients vs 1/10 of confirmed Parkinson’s patients responded with mild improvement in symptoms.

As the number of patients studied does not meet criteria for statistical significance, no definitive conclusion can be drawn from our study. Clinicopathological discrepancies may have a significant impact on patient care and response to intervention. Increasing the identification of patient diagnostic discrepancies through autopsy and subsequent clinicopathologic correlation can help identify major contributors to false positive diagnosis and broader inclusion in the differential diagnosis