Adachi Michito, Kawanami Toru, Ohshima Humi, Sugai Yukio, Hosoya Takaaki
Department of Radiology, Ohshima Clinic, Yamagata, Japan.
Magn Reson Med Sci. 2004 Dec 15;3(3):125-32. doi: 10.2463/mrms.3.125.
We have encountered a peculiar atrophic change in the midbrain in some patients with parkinsonian syndromes. We discovered these patients had vertical supranuclear gaze-palsy, an eye movement disorder. The purpose of this study was to elucidate whether this atrophic pattern of the midbrain (which we have termed morning glory sign) is related to the vertical eye movement disorder, in particular to progressive supranuclear palsy (PSP).
We reviewed T2-weighted axial images obtained from 42 patients with parkinsonian syndromes, including five patients with PSP, 23 patients with Parkinson's disease, and 14 patients with multiple system atrophy (MSA). We focused on a specific atrophy of the midbrain, the morning glory sign, which is a concavity of the lateral margin of the tegmentum of the midbrain.
The morning glory sign was detected in four of the five patients with PSP and in one (striatonigral degeneration; SND) of the14 patients with MSA. All morning glory sign patients had vertical supranuclear gaze-palsy, as did the one PSP patient without the morning glory sign. Vertical supranuclear gaze-palsy was seen in no other patients (23 patients with Parkinson's disease and 13 patients with MSA) who lacked the morning glory sign.
Morphologically, the morning glory sign is believed to be related to vertical supranuclear gaze-palsy. This sign should be considered a useful clue when diagnosing PSP.
我们在一些帕金森综合征患者的中脑发现了一种特殊的萎缩性改变。我们发现这些患者存在垂直性核上性凝视麻痹，这是一种眼球运动障碍。本研究的目的是阐明中脑的这种萎缩模式（我们称之为牵牛花征）是否与垂直性眼球运动障碍有关，特别是与进行性核上性麻痹（PSP）有关。
我们回顾了42例帕金森综合征患者的T2加权轴位图像，其中包括5例PSP患者、23例帕金森病患者和14例多系统萎缩（MSA）患者。我们重点关注中脑的一种特定萎缩，即牵牛花征，它是中脑被盖外侧缘的凹陷。
5例PSP患者中有4例检测到牵牛花征，14例MSA患者中有1例（纹状体黑质变性；SND）检测到该征。所有有牵牛花征的患者均有垂直性核上性凝视麻痹，没有牵牛花征的1例PSP患者也有该症状。在没有牵牛花征的其他患者（23例帕金森病患者和13例MSA患者）中未发现垂直性核上性凝视麻痹。
从形态学上看，牵牛花征被认为与垂直性核上性凝视麻痹有关。在诊断PSP时，该征象应被视为一个有用的线索。
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