Neurodegenerative features in developmental brain disorders

Extensive Delayed Brain Atrophy after Resuscitation in a Patient with Multiple System Atrophy

Brain magnetic resonance imaging (MRI) of multiple system atrophy (MSA) shows atrophy in the cerebrum, cerebellum, and brainstem. It is also characterized by specific patterns such as hyperintense lateral putaminal rim. MRI of hypoxic encephalopathy shows atrophy mainly in the gray matter, and laminar necrosis in the cerebral cortex is often observed. Here, we report an MSA patient damaged by hypoxic insult and resuscitated after 18-min cardiac arrest. The brain of the patient developed severe atrophy within a period of 10 months. Furthermore, brain atrophy was observed in the white and gray matter, which preserved the brain atrophy pattern in MSA. We assume that alpha-synuclein oligomerization is involved in the neural cell death and brain atrophy. It might have caused further neural cell death in the brain damaged by hypoxia. Alpha-synuclein, which is involved in the pathogenesis of MSA, is suggested to be a prion. Misfolded alpha-synuclein may propagate through cell-to-cell transmission and cause wide pathological change, visible as atrophied MR imaging.

Lesions in the central tegmental tract in autopsy cases of developmental brain disorders

We retrospectively analyzed central tegmental tract (CTT) lesions in 120 consecutive autopsy cases of developmental brain disorders to investigate the significance of symmetrical CTT lesions. Magnetic resonance imaging (MRI) findings of CTT lesions have been sporadically reported in various cases of child neurological diseases. In this study, symmetrical CTT lesions were observed in 25 (20.8%) among 120 cases of developmental brain disorders. These 25 cases were classified into three groups (groups I-III) in decreasing order of the severity of the lesion. Compared to five cases of group I in which CTT lesions were accompanied by diffuse tegmental damage, 20 cases of groups II or III developed relatively selective CTT lesions in which the medial longitudinal fasciculus and/or medial or lateral lemniscus were preserved. The causes of brain disorders in all three groups seemed to be different, and lysosomal disorders and congenital brain anomalies were frequently seen in cases in groups II and III, respectively. The dentato-rubro-olivary system is known to be involved in palatal myoclonus, and five out of 13 cases in group II showed myoclonic epilepsy. Compared with 95 cases without the CTT lesion, the changes in the pontine reticular formation were more closely associated with the CTT lesion than those in the inferior olivary nucleus. In conclusion, in cases of developmental brain disorders, the neuropathology of the symmetrical CTT lesion should be investigated.