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KMID : 0359720200380030194
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Journal of the Korean Neurological Association
2020 Volume.38 No. 3 p.194 ~ p.203
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Comparison of Neuropathological Characteristics between Multiple System Atrophy Cerebellar Type and Parkinsonian Type
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Kim Eun-Joo
Lee Suk-Min
Jang Sung-Hwan
Lee Myung-Jun
Lee Jae-Hyeok
Shin Jin-Hong
Lee Young-Min
Pak Kyoung-June
Jung Na-Yeon
Yoon Jin-A
Ko Jun-Kyeung
Lee Jae-Meen
Lee Kang-Yoon
Hwang Chung-Su
Ahn Jae-Woo
Sung Suk
Choi Kyung-Un
Huh Gi-Yeong
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Abstract
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Background: Multiple system atrophy (MSA) is a sporadic neurodegenerative disease characterized by various combinations of parkinsonism, cerebellar ataxia, autonomic dysfunction and pyramidal signs. Two clinical subtypes are recognized: MSA with predominant cerebellar ataxia (MSA-C) and MSA with predominant parkinsonism (MSA-P). The aim of this study was to compare pathological features between MSA-C and MSA-P.
Methods: Two autopsy confirmed cases with MSA were included from the Pusan National University Hospital Brain Bank.
Case 1 had been clinically diagnosed as MSA-C and case 2 as MSA-P. The severity of neuronal loss and gliosis as well as the glial and neuronal cytoplasmic inclusions were semiquantitatively assessed in both striatonigral and olivopontocerebellar regions. Based on the grading system, pathological phenotypes of MSA were classified as striatonigral degeneration (SND) predominant (SND type), olivopontocerebellar degeneration (OPC) predominant (OPC type), or equivalent SND and OPC pathology (SND=OPC type).
Results: Both cases showed widespread and abundant α-synuclein positive glial cytoplasmic inclusions in association with neurodegenerative changes in striatonigral or olivopontocerebellar structures, leading to the primary pathological diagnosis of MSA. Primary age-related tauopathy was incidentally found but Lewy bodies were not in both cases. The pathological phenotypes of MSA were MSA-OPC type in case 1 and MSA-SND=OPC type in case 2.
Conclusions: Our data suggest that clinical phenotypes of MSA reflect the pathological characteristics.
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KEYWORD
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Multiple system atrophy-cerebellar type, Multiple system atrophy-parkinsonian type, α-synuclein, Glial cytoplasmic inclusion
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