[An autopsy case of a 76-year-old woman with progressive supranuclear palsy initially presenting with dropped head and clinical features of pure akinesia with gait freezing].

Q4 Medicine
Ken Yamamoto, Kenji Ishihara, Yukiko Mori, Yasushi Iwasaki, Mari Yoshida, Hidetomo Murakami
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引用次数: 0

Abstract

We present a case of a 76-year-old woman diagnosed with pathologically confirmed progressive supranuclear palsy (PSP) with pallido-nigral-luysial atrophy, who initially presented with a dropped head. Upon her first visit, neurophysiological and neuroradiological examinations provided no definitive cause, and the tactile trick was effective, leading to a diagnosis of cervical dystonia. Trihexyphenidyl treatment had no effect, but her condition gradually improved over 3 years. By age 74, she developed gait freezing without muscle rigidity or tremor. Dopamine-transporter scintigraphy revealed reduced tracer uptake in the bilateral corpus striata, prompting the diagnosis of pure akinesia with gait freezing (PAGF). At age 76, the patient developed retrocollis, muscle rigidity in all extremities, and recurrent temporomandibular dislocation. She eventually died from aspiration pneumonia after several years of illness. At autopsy, the brain weighed 1,370 ‍g. Macroscopic examination showed atrophy of the pallidum and subthalamic nucleus and depigmentation of the substantia nigra. Histopathological analysis revealed degeneration with 4-repeat tau pathology in the substantia nigra, globus pallidus, and subthalamic nucleus, along with tufted astrocytes in the globus pallidus and putamen, confirming a pathological diagnosis of pallido-nigral-luysial atrophy-type PSP. We suggest that the clinical presentation of PAGF correlates well with the pathological findings of pallido-nigral-luysial atrophy. While dystonia in PSP is typically observed in the limbs, blepharospasm, or retrocollis, only two other cases of PSP with a dropped head have been reported. The pathophysiological mechanism remains unclear, but we hypothesize that 4-repeat tau pathology in the globus pallidus may contribute to the development of cervical dystonia. Further neuropathological studies are needed to confirm this hypothesis.

[尸检一例76岁女性进行性核上性麻痹,最初表现为头部下垂,临床表现为纯运动障碍伴步态冻结]。
我们提出一个病例76岁的妇女诊断为病理证实进行性核上性麻痹(PSP)与苍白球-黑神经-脑萎缩,谁最初提出了一个下降的头。在她第一次就诊时,神经生理学和神经放射学检查没有提供明确的病因,触觉技巧有效,导致诊断为宫颈肌张力障碍。三己苯肼治疗无效,但病情在3年内逐渐好转。到74岁时,她出现了步态冻结,没有肌肉僵硬或震颤。多巴胺转运体显像显示双侧纹状体示踪剂摄取减少,提示单纯运动障碍伴步态冻结(PAGF)的诊断。76岁时,患者出现后颈、四肢肌肉僵硬和复发性颞下颌关节脱位。在患病数年后,她最终死于吸入性肺炎。在尸检中,大脑重1370‍g。肉眼检查显示脑白质和丘脑下核萎缩,黑质色素沉着。组织病理学分析显示黑质、苍白球和丘脑底核变性伴4重复tau病理,以及苍白球和壳核的丛状星形胶质细胞,病理诊断为苍白球-黑质-黄质萎缩型PSP。我们认为PAGF的临床表现与苍白球-黑神经-胼胝体萎缩的病理表现密切相关。虽然PSP的肌张力障碍通常在四肢、眼睑痉挛或后倾中观察到,但只有另外两例PSP伴有头部下垂的病例被报道过。病理生理机制尚不清楚,但我们假设苍白球的4-repeat tau病理可能有助于颈肌张力障碍的发展。需要进一步的神经病理学研究来证实这一假设。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Neurology
Clinical Neurology Medicine-Neurology (clinical)
CiteScore
0.30
自引率
0.00%
发文量
147
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