Yagishita T, Kojima S, Hirayama K
Department of Neurology, Chiba University School of Medicine.
Rinsho Shinkeigaku. 1995 Feb;35(2):126-31.
The characteristic morphological changes of the brainstem and cerebellar regions of multiple system atrophy (MSA) were studied by MRI in varying subtypes, that is olivoponto cerebellar atrophy (OPCA: 23 cases), striatonigral degeneration (SND: 7 cases) and Shy-Drager's syndrome (SDS: 9 cases). OPCA was characterized by atrophy of the entire regions of the brainstem and the cerebellum. SND and SDS tended to show atrophy similar in type but lessin extent to OPCA. The common lesions in MSA were atrophy of the pontine base and cerebellum, and dilation of the fourth ventricle. Atrophy of the pontine base was more dominant in the inferior part than in the superior part, and cerebellar atrophy was more dominant in the superior part than in the inferior part, indicating that degeneration of the pontocerebellar pathway proceeds principally along fibers connecting the inferior part of the pons and the superior part of the cerebellum. Dilation of the fourth ventricle indicated atrophy of the middle cerebellar peduncle. In almost all the cases of OPCA and about a half the cases of SND and SDS, the pontine base and the middle cerebellar peduncle appeared as high signal intensity on T2 weighted image and as low intensity on T1, suggesting degeneration and demylination. In a few cases of OPCA, the dorsolateral part of the putamen were demonstrated as low signal intensity on T2 weighted image.
通过磁共振成像（MRI）研究了多系统萎缩（MSA）不同亚型脑干和小脑区域的特征性形态学变化，即橄榄脑桥小脑萎缩（OPCA：23例）、纹状体黑质变性（SND：7例）和Shy-Drager综合征（SDS：9例）。OPCA的特征是脑干和小脑的整个区域萎缩。SND和SDS倾向于表现出与OPCA类型相似但程度较轻的萎缩。MSA的常见病变是脑桥基底部和小脑萎缩以及第四脑室扩张。脑桥基底部萎缩在下半部分比上半部分更明显，小脑萎缩在上半部分比下半部分更明显，这表明脑桥小脑通路的退变主要沿着连接脑桥下部和小脑上部的纤维进行。第四脑室扩张表明小脑中脚萎缩。几乎所有OPCA病例以及约一半的SND和SDS病例中，脑桥基底部和小脑中脚在T2加权图像上呈高信号强度，在T1加权图像上呈低信号强度，提示退变和脱髓鞘。在少数OPCA病例中，壳核的背外侧部分在T2加权图像上呈低信号强度。
