Differential diagnostic relevance of high resolution magnetic resonance in patients with possible multiple system atrophy (MSA) – a case report [Važnost uporabe magnetne rezonancije visoke rezolucije u dijagnostici moguće multiple sistemske atrofije - prikaz slučaja]

Bačić Baronica, Koraljka and Ivkić, Goran and Ozretić, David and Miličević, Goran (2011) Differential diagnostic relevance of high resolution magnetic resonance in patients with possible multiple system atrophy (MSA) – a case report [Važnost uporabe magnetne rezonancije visoke rezolucije u dijagnostici moguće multiple sistemske atrofije - prikaz slučaja]. Collegium Antropologicum, 35 (S. 1). pp. 287-292. ISSN 0350-6134

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Abstract

Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized clinically by autonomic dysfunction, Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combination. Parkinsonism is present in the majority of patients (80%). Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients, while the domination of cerebellar symptoms is present in 20% of all patients1,2. According to second consensus statement on diagnosis of MSA, to make the diagnosis of possible MSA, except Parkinsonism or a cerebellar syndrome, there must be one feature involving autonomic dysfunction plus one other additional that can include findings on history, clinical examination or changes in structural or functional imaging3. We present a case of 60-year old male with Parkinsonism and cerebellar symptoms accompanied with signs of autonomic nervous system involvment. Level of autonomic dysfunction was not the level required for the diagnosis of probable MSA. On initially performed 1.5T MRI, the most prominent neurodegenerative feature of brain stem, cerebellum and basal ganglia was atrophy, however features like »hot-cross bun« sign, »slit-like« putaminal rim and middle cerebellar peduncle hyperintensities were detected only after MR imaging on higher resolution (3T) device4. Our case points to the possibility that some typical structural changes that can help in diagnostic process may not be clearly visible on 1.5 T MRI devices. In such cases we suggest using 3T MRI device, if feasible, in order to demonstrate findings that may help in establishing the diagnosis of possible MSA.

Abstract in Croatian

Multipla sistemna atrofija (MSA) je sporadična, progresivna neurodegenerativna bolest klinički karakterizirana znakovima autonomne disfunkcije, parkinsonizma (MSA-P) i cerebelarnim simptomima (MSA-C) u bilo kojoj kombinaciji. Parkinsonizam je prisutan u većine bolesnika (80%). U početku bolesti autonomna disfunkcija je izražena kod otprilike 40% bolesnika dok je kod 20% bolesnika dominantna cerebelarna simtomatologija (1,2). Prema kriterijima za dijagnozu MSA koje su postavili eksperti na drugoj konferenciji o dijagnostici MSA za dijagnozu moguće MSA uz postojanje parkinsonizma ili cerebelarnih simptoma moraju postojati i znaci autonomne disfunkcije i jedna od dodatnih karakteristika koje uključuju anamnezu, klinički nalaz ili strukturne ili funkcionalne promjene verificirane slikovnim metodama (3). Prikazujemo šezdesetgodišnjeg bolesnika sa parkinsonizmom, cerebelarnim simptomima i znacima zahvaćanja autonomnog živčanog sustava čiji stupanj prema zadanim kriterijima nije dovoljan za dijagnozu vjerojatne MSA. Rezultati laboratorijske obrade su bili unutar granica normale. Na inicijalno učinjenoj magnetnoj rezonanciji (MR) mozga vidljiva je atrofija moždanog debla, malog mozga i bazalnih ganglija. Promjene tipične za MSA kao »hot-cross bun« znak, hiperdenzni posterolateralni rub putamena i hiperdenzni srednji cerebelarni pedunkuli su bili detektirani korištenjem MR aparata jačine 3 T (4). Naš slučaj ukazuje na mogućnost da se neke strukturalne promjene mozga koje mogu pomoći u dijagnozi moguće MSA ne moraju uvijek jasno prikazati korištenjem MR mozga jačine 1.5 T te stoga preporučamo, ukoliko je izvedivo, korištenje aparata jače rezolucije u svrhu prikaza karakteristika koje mogu pomoći u postavljanju dijagnoze moguće MSA.

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