A 53-year-old male with clumsiness Leonidas Arvanitis, M.D. Neuropathology Fellow, PGY-6.
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Transcript of A 53-year-old male with clumsiness Leonidas Arvanitis, M.D. Neuropathology Fellow, PGY-6.
A 53-year-old male with clumsiness
Leonidas Arvanitis, M.D.
Neuropathology Fellow, PGY-6
History• The patient was a 53 year male with a 10 year
history of clumsiness• He initially presented with deterioration of his
singing voice, clumsiness of his left hand, incoordination and spastic reflexes.
• The patient had no history of drug abuse or environmental exposure.
• An MRI of the brain was normal, but a cervical MRI revealed a small syrinx below C6-7.
History• His symptoms progressed, notable for masked
facies, increased muscle upper extremity muscle tone, and poor gait and arm.
• One year before death the patient was also noted to have dementia, the latter manifesting in cognitive difficulty, paranoia, and delusions, but improving with medications.
Autopsy• An autopsy was performed and showed
the following (describe midbrain section):
http://library.med.utah.edu/WebPath/CNSHTML/CNS102.html
Our case Normal control
Autopsy
http://library.med.utah.edu/WebPath/CNSHTML/CNS102.html
Our case Normal control
Marked pallor of substantia nigra
This is a section from the midbrain. What do you see?
Midbrain. (Click here for H&E)
This is a section from the midbrain. What do you see?Midbrain. (Click here for H&E)
This is a section from the midbrain. What do you see?Midbrain. (Click here for H&E)
Eosinophilic cytoplasmic inclusions
Decreased numbers of pigmented neurons
This is a section from the midbrain. What do you see?Midbrain. (Click here for H&E)
Pigmented-laden macrophages
Reactive gliosis
Question:
• The intracytoplasmic neuronal inclusions are known as …
Answer
• …Lewy bodies
Question:
• Which immunohistochemical stain highlights the Lewy bodies?
Answer
• A-synuclein– Click here to view stain
Lewy bodies (a-synuclein)
Question
• What is the diagnosis?
Answer
• Parkinson’s disease
Question
• What is the most common cause of Parkinson’s disease?
Answer
• Most cases are sporadic of unknown etiology
• Environmental factors such as toxic exposure, infection or lifestyle have been proposed
Question
• Are there any gene mutations linked to Parkinson's disease?
Answer
• Yes. Autosomal dominant and recessive mutations– Autosomal dominant include PARK1 point
mutation in a-synuclein gene and PARK5 point mutation in ubiquitin carboxyterminal hydrolase-L1 (UCH-L1)
– Autosomal recessive include PARK2 mutation in the parkin gene
http://neurowiki2013.wdfiles.com/local--files/individual%3Agenetic-etiology-of-parkinson-s-disease/img2.JPG