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Case Reports
. 2023 Jun 20;18(9):2975-2977.
doi: 10.1016/j.radcr.2023.05.060. eCollection 2023 Sep.

Asymmetrical putaminal atrophy in parkinsonism-predominant multiple system atrophy (MSA-P): A case report

Koichiro Mori  1   2 , Akira Yagishita  1 , Toshio Shimizu  1
Affiliations
Case Reports

Asymmetrical putaminal atrophy in parkinsonism-predominant multiple system atrophy (MSA-P): A case report

Koichiro Mori et al. Radiol Case Rep. .

Abstract

We encountered a case of multiple system atrophy parkinsonian subtype (MSA-P) with right-dominant parkinsonism in the early stage of the disease. Atrophy of the posterolateral putamen and iron deposition are the neuropathological hallmark of MSA-P. Coronal fluid-attenuated inversion-recovery (FLAIR) images showed atrophy and iron deposition in the left posterior putamen contralateral to the clinical dominant side in the early phase. Atrophy in the posterior putamen of patients with MSA-P was more clearly observed on coronal FLAIR images than on axial T2-weighted images. These findings reflected the pathological changes and might be a pathognomonic sign of MSA-P.

Keywords: Asymmetrical parkinsonism; FLAIR; Lateral medullary laminae; Putamen.

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Figures

Fig 1
Fig. 1.
(A) Coronal fluid-attenuated inversion-recovery (FLAIR) image shows hypointensity in the left posterior putamen (arrowheads), which is clearly atrophic compared to that in the right putamen. The left lateral medullary lamina (arrow) is clearly visible and separated from the left atrophic putamen. The external globus pallidus shows hypointensity due to age-related iron deposition (dotted arrow). On the right side, the lateral medullary lamina (arrow) is also observed between the right putamen (arrowheads) and the external globus pallidus (dotted arrow). The right putamen is normal. (B) T2 weighted image (T2WI) reveals atrophy in the left putamen and hypointensity in the lateral side of the putamen (arrowheads) indicating iron deposition.
Fig 2
Fig. 2.
(A) In the coronal FLAIR image taken 2 years later, atrophy is observed in the right putamen (arrowheads) in addition to that in the left putamen (arrowheads). Moreover, the right posterior putamen has hypointensity. The lateral medullary lamine (arrows) can be identified on both sides. (B): T2WI shows progressive atrophy in the left putamen and hypointensity in the lateral side of the putamen (arrowheads). Hypointensity is also observed in the lateral side of the right putamen (arrowhead).
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