Clinical and magnetic resonance imaging study of extrapyramidal symptoms in multiple system atrophy.

Konagaya, Masaaki; Konagaya, Yoko; Iida, Madoka

doi:10.1136/jnnp.57.12.1528

Cited by 76 publications

(46 citation statements)

References 8 publications

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“…The present study indicates that neurodegeneration in the internal segment of the globus pallidus of MJD patients progressed after their initial symptoms. We also investigated pontine T2 high-intensity change, which exhibits the cross shape typical in MSA patients [1,4,8,11,13,16]. This characteristic change was also reported in MJD cases [6,9,10].…”

Section: Discussionmentioning

confidence: 88%

Longitudinal study on MRI intensity changes of Machado–Joseph disease: correlation between MRI findings and neuropathological changes

et al. 2011

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To disclose the neuropathological progression course of Machado-Joseph disease (MJD), magnetic resonance imaging (MRI) findings of six genetically confirmed MJD cases (four males and two females, including an autopsied female, all unrelated to one another) were further investigated on neurodegeneration. Brain MRI studies were repeated in all cases at different stages of the disease. Ages at the first MRI study ranged from 47 to 65 years (55.2 ± 7.1), with observation periods from 4.5 to 10.6 years (6.95 ± 2.48). We paid particular attention to two types of previously reported MRI findings detectable using T2-weighted images. One is located just outside the internal capsules, and another in the pons. A linear high-intensity change along the internal capsules was detected in all cases, and showed progression during the observation period. A comparison between MRI and autopsy findings suggested that the lesion might reflect degeneration with neuronal loss, astrocytosis, and gliosis in the internal segment of the globus pallidus. A cross-shaped high-intensity change in the pons was well advanced but still incomplete in all cases. In this region, pontine transverse fibers were atrophic, while longitudinal fibers remained intact. Pontine nuclei showed apparent nerve cell loss, and the remaining cells had many 1C2-positive intranuclear inclusions. Since these findings were detected both by lifetime images and by postmortem examination, MRI intensity changes could track the progression of neurodegeneration. Based on a comparison between MRI findings and neuropathology, the degeneration of an internal segment of the globus pallidus (one of the pathological features of MJD) had progressed following the initial symptoms.

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Section: Discussionmentioning

confidence: 88%

Longitudinal study on MRI intensity changes of Machado–Joseph disease: correlation between MRI findings and neuropathological changes

et al. 2011

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“…2A). Another is linear T2 high intensity in the dorsolateral margin of the putamen ("putaminal slit") [7,13] (Fig. 2B).We investigated the latter since we used the 0.2 tesla device, which could not show reduced intensity of the putamen but was effective at depicting linear high intensity.…”

Section: Methodsmentioning

confidence: 97%

“…istic features by magnetic resonance imaging (MRI) such as atrophy of the brainstem and cerebellum, or pontine and putaminal intensity changes in T2 weighted imaging [3,7,12,13]. In particular, pontine or putaminal intensity changes are considered to reflect pathological changes.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal MRI study of multiple system atrophy - when do the findings appear, and what is the course?

Horimoto

Aiba

Yasuda

et al. 2002

Journal of Neurology

112

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Several investigators have revealed features of multiple system atrophy (MSA) by magnetic resonance imaging (MRI). For use in clinical diagnosis, we determined the exact time when two main features of pontine and putaminal intensity changes appeared. Furthermore, in order to reveal the course from when the disorder first appeared and how it spread, we also investigated the course of MRI findings and differences between clinical subtypes. The cranial MRI of 42 patients with MSA were longitudinally studied including comments on the so called "cross sign" of pontine T2 high intensity, which was divided into 6 stages, and also on the linear T2 high intensity of the dorsolateral side of the putamen ("putaminal slit") which was divided into 4 stages. Patients were classified as 16 MSA-C, 7 autonomic dominant type (MSA-A), and 19 MSA-P. The age at onset ranged from 41 to 74 years (mean, 55 +/- 9). The duration of the disease in the MRI study ranged from 1 to 24 years. The pontine "cross sign" was completed (shows Cross, stage IV) earlier in MSA-C mainly before 5 years, later in MSA-P and even much later in MSA-A. Regarding the "putaminal slit", MSA-P shows earlier bilateral changes (stage II), mostly before 3 years, compared with MSA-C, which requires 4 years to reveal even a unilateral change (stage I), or MSA-A which requires even more time. MRI findings showed a tendency to relate to clinical findings, since MSA-C exhibits "cross sign" completion earlier than bilateral "putaminal slit"; however, MSA-P shows bilateral "putaminal slit" earlier than "cross sign", and MSA-A requires much more time to show both. Clinically, MSA-C, MSA-A, or MSA-P showed different MRI courses so that three subtypes could be defined also with MRI findings. Therefore these observations are useful not only for diagnosis of MSA itself, but also to distinguish clinical subtypes (MSA-C, MSA-A, or MSA-P) which have different rates of lesion progression.

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“…HPR is one such finding, reflecting degeneration of the putaminal lateral margin and/or the external capsule, and correlates with contralateral extrapyramidal symptoms [12,20]. The degree of hyperintensity also correlates with the severity of rigidity and can produce false-negative results in early-stage cases [9,11].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, MRI can be helpful for the diagnosis of MSA-P [8]. A hyperintense putaminal rim (HPR) is an important MRI finding for differentiating MSA-P from PD, displaying a sensitivity ranging from 38 to 83% [9,10,11,12,13], and is generally evaluated on T 2 -weighted (T2W) or proton-density-weighted sequences. …”

Section: Introductionmentioning

confidence: 99%

Utility of the Fluid-Attenuated Inversion Recovery Sequence in Detecting a Hyperintense Putaminal Rim in Multiple System Atrophy-Parkinsonism: A Preliminary Study

Sakurai

Yamawaki²,

Okita³

et al. 2011

Eur Neurol

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Objective: To investigate the utility of fluid-attenuated inversion recovery (FLAIR) imaging for diagnosing multiple system atrophy-parkinsonism (MSA-P). Methods: We retrospectively evaluated 49 subjects (19 with MSA-P including 11 with early-stage disease, 15 with Parkinson’s disease and 15 matched controls) in order to compare the diagnostic value of FLAIR imaging to detect a hyperintense putaminal rim (HPR) with that of T₂-weighted (T2W) imaging. Results: Compared with T2W imaging, FLAIR imaging detected HPR more conspicuously in the 19 MSA-P patients (p = 0.01); this trend was also observed in 11 early-stage MSA-P patients (p = 0.01). Furthermore, FLAIR imaging tended to increase sensitivity of detecting HPR compared with T2W imaging (all patients: 89 vs. 58%, p = 0.07; early-stage patients: 100 vs. 55%, p = 0.06). Conclusions: FLAIR imaging might be more useful for detecting HPR in MSA-P patients, even though they are at an early stage.

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Clinical and magnetic resonance imaging study of extrapyramidal symptoms in multiple system atrophy.

Cited by 76 publications

References 8 publications

Longitudinal study on MRI intensity changes of Machado–Joseph disease: correlation between MRI findings and neuropathological changes

Longitudinal study on MRI intensity changes of Machado–Joseph disease: correlation between MRI findings and neuropathological changes

Longitudinal MRI study of multiple system atrophy - when do the findings appear, and what is the course?

Utility of the Fluid-Attenuated Inversion Recovery Sequence in Detecting a Hyperintense Putaminal Rim in Multiple System Atrophy-Parkinsonism: A Preliminary Study

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