Limbic and nigral Lewy bodies and Alzheimer's disease pathology mimicking progressive supranuclear palsy in a 75-year-old man with preserved cardiac uptake of MIBG.

Abstract

A 75-year-old man developed l-dopa non-responsive parkinsonism, supranuclear ophthalmoplegia, neck dorsiflexion, and dementia. Atrophy of the midbrain tegmentum on MRI and normal myocardial uptake of MIBG led to the clinical diagnosis of progressive supranuclear palsy (PSP). Autopsy revealed depigmentation of the substantia nigra and locus ceruleus. Alzheimer's disease pathology was advanced with PSP-like neurofibrillary tangles distribution, and Lewy bodies were abundant in limbic lobe, while scarce in lower brainstem nuclei. Tuft-shaped astrocytes were not apparent. Although decreased myocardial uptake of MIBG is a rule in patients harboring Lewy bodies, its normal uptake may be related to their absence in lower brainstem nuclei.

• Authors: Naoki Kasahata, Toshiki Uchihara, Satoshi Orimo, Ayako Nakamura, Yoshihisa Makita
• Journal: Journal of Alzheimer's disease : JAD (J Alzheimers Dis) Vol. 32 Issue 4 Pg. 889-94 ( 2012) ISSN: 1875-8908 [Electronic] Netherlands
• PMID: 22886008 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• 3-Iodobenzylguanidine

Topics

• 3-Iodobenzylguanidine (metabolism)
• Aged
• Alzheimer Disease (complications, diagnosis, metabolism)
• Diagnosis, Differential
• Humans
• Lewy Bodies (metabolism, pathology)
• Limbic System (metabolism, pathology)
• Magnetic Resonance Imaging
• Male
• Myocardium (metabolism)
• Substantia Nigra (metabolism, pathology)
• Supranuclear Palsy, Progressive (complications, diagnosis, metabolism)