Seo Jeong Pyo, Chang Min Cheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea.
Medicine (Baltimore). 2017 May;96(19):e6840. doi: 10.1097/MD.0000000000006840.
To report a patient with primary progressive freezing gait (PPFG) whose degeneration of corticofugal tract (CFT) from the supplementary motor area (SMA) was demonstrated using diffusion tensor tractography (DTT).
A 66-year-old woman presented with a solitary symptom of a sudden transient break on walking (i.e., freezing gait), which slowly progressed for 4 years.
Imaging evidence using magnetic resonance imaging and F-florinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-lodophenyl) nortropane positron emission tomography scanning was unremarkable, and our patient's symptom was not affected by dopamine agonist medication. Based on the clinical symptoms and imaging findings, we diagnosed our patient as having PPFG.
From the patient and 20 age- and sex- matched normal controls, diffusion tensor imaging data were acquired using a 1.5 T magnetic resonance scanner.
In DTT findings, the CFT from the left SMA was partially torn and thinned. Moreover, the fractional anisotropy value and tract volume of CFT from the left SMA were more than two standard deviations lower than those of normal controls.
In our opinion, the lesion in the CFT from the left SMA in our patient was attributed to the occurrence of PPFG. We believe that the results of this study suggest one of the pathological mechanisms for the occurrence of gait difficulty in PPFG.
报告一例原发性进行性冻结步态（PPFG）患者，其通过弥散张量纤维束成像（DTT）显示了来自辅助运动区（SMA）的皮质传出束（CFT）退变。
一名66岁女性，仅表现为行走时突然短暂停顿（即冻结步态）这一孤立症状，该症状缓慢进展4年。
磁共振成像和F-氟代-N-3-氟丙基-2-β-羧甲氧基-3-β-（4-碘苯基）去甲托烷正电子发射断层扫描的影像学证据无明显异常，且患者症状不受多巴胺激动剂药物影响。基于临床症状和影像学表现，我们将患者诊断为PPFG。
使用1.5T磁共振扫描仪采集患者及20名年龄和性别匹配的正常对照者的弥散张量成像数据。
在DTT结果中，来自左侧SMA的CFT部分撕裂且变细。此外，来自左侧SMA的CFT的分数各向异性值和纤维束体积比正常对照者低超过两个标准差。
我们认为，患者左侧SMA的CFT病变归因于PPFG的发生。我们相信本研究结果提示了PPFG中步态困难发生的一种病理机制。
