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NeuroImages
May 8, 2001
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FLAIR MRI of striatonigral degeneration

May 8, 2001 issue
56 (9) 1200
A 43-year-old woman had cogwheel rigidity, bradykinesia, bowel/bladder retention, and tongue tremor (levodopa-nonresponsive). Brisk deep tendon reflexes and extensor plantar responses were noted. MRI is shown (figure). SPECT showed striatal hypoperfusion. Multiple system atrophy/striatonigral degeneration (MSA/SND) was diagnosed.
Figure. Axial T2 (A–B) and fluid attenuated inversion recovery (FLAIR) (C–D) MRI, performed as detailed.2 The patient (A–C) has posterior/lateral putamen hypointensity (iron deposition) (A–B). The patient’s FLAIR (C) shows linear lateral putamen hyperintensities (arrows), seen better on FLAIR than on T2 (B). Such hyperintensities are absent on FLAIR from an age-matched, healthy control (D).
The combination of linear T2 hyperintense putamenal rims and medial putamenal hypointensity suggests MSA/SND.1 FLAIR uses CSF suppression and strong T2 weighting, producing better lesion/tissue contrast than standard T2 images in the brain.2 Our case shows the better depiction of hyperintense rims on FLAIR as compared with T2 images in MSA/SND, suggesting that FLAIR is useful in the evaluation of atypical parkinsonism.

References

1.
Kraft E, Schwarz J, Trenkwalder C, et al. The combination of hypointense and hyperintense signal changes on T2-weighted magnetic resonance imaging sequences: a specific marker of multiple system atrophy? Arch Neurol . 1999; 56: 225–228.
2.
Bakshi R, Ariyaratana S, Benedict RHB, Jacobs L. Fluid-attenuated inversion-recovery MRI detects cortical and juxtacortical multiple sclerosis lesions. Arch Neurol 2001 (in press).

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Published In

Neurology®
Volume 56Number 9May 8, 2001
Pages: 1200
PubMed: 11342686

Publication History

Published online: May 8, 2001
Published in print: May 8, 2001

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Sandra A. Block, MD
Rohit Bakshi, MD

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Cited By
  1. Early Motor Fluctuations in a Patient with Striatonigral Degeneration, Case Reports in Neurology, 8, 3, (243-250), (2016).https://doi.org/10.1159/000453254
    Crossref
  2. Differentiating multiple-system atrophy from Parkinson's disease, Clinical Radiology, 70, 5, (555-564), (2015).https://doi.org/10.1016/j.crad.2015.01.005
    Crossref
  3. Iron in chronic brain disorders: Imaging and neurotherapeutic implications, Neurotherapeutics, 4, 3, (371-386), (2007).https://doi.org/10.1016/j.nurt.2007.05.006
    Crossref
  4. Magnetic Resonance Imaging of Iron Deposition in Neurological Disorders, Topics in Magnetic Resonance Imaging, 17, 1, (31-40), (2006).https://doi.org/10.1097/01.rmr.0000245459.82782.e4
    Crossref
  5. Comparison of magnetic resonance imaging in subtypes of multiple system atrophy, Parkinsonism & Related Disorders, 10, 6, (363-368), (2004).https://doi.org/10.1016/j.parkreldis.2004.04.008
    Crossref
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