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Brain Iron in Parkinson’s Disease

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It's important,

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when discussing classic Parkinson's disease or PD,

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to have an understanding of brain

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iron distribution stores.

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Now, brain iron doesn't start to accumulate until

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about 12 or 13 years of age.

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And there are typical territories,

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many of which I'm showing you here on this coronal

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pathologic anatomic specimen of a real brain,

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demonstrating brain iron staining,

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including the caudoputamenal

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or corpus striatum region.

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You're seeing the head and body of the caudate nucleus.

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And yes, there is a tail,

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there is an inner and outer aspect of the putamen.

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We actually can't subdivide these

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on this particular stain,

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but outside the putamen is the external capsule,

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devoid of iron, then the gray matter,

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claustrum with iron, then the extreme capsule,

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and then the centro sylvian cortex.

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The globus pallidus,

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has variable amounts of iron with a GPI,

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the globus pallidus inner component, and a GPE,

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the globus pallidus external component.

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The GPI demonstrates or exerts a restraint on

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secretory behavior and nerve behavior

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in the thalamus and in the midbrain.

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And it's the loss of this restraint that

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accounts for many movement disorders.

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Now, we're able to separate the GPE from

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the GPI, external from internal,

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and that moves us over towards the midbrain,

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where we have the nucleus ruber or red nucleus,

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and the substantia nigra.

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Now, in the normal setting,

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we see the reticular layer of the substantia nigra,

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which is this outer component right here,

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and then the nucleus ruber,

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or red nucleus, right there.

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And they are separated by a non-stained area,

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which will show up less dark on the MRI because

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of the paucity of iron present.

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But when iron accumulates in this area,

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I'll make it a slightly different color,

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maybe a little orange.

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As iron accumulates right in the middle,

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these two areas will start to bleed together

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and this stripe is then lost.

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That is one of the signs of classic Parkinson's disease.

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Now, unfortunately,

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it doesn't have a very high specificity for it,

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but in mid to late-stage Parkinson's disease,

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the absence of it is an important distinguisher

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of pseudoparkinsonian syndromes.

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So, you would like to see it in

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mid to late-stage disease.

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We'll also talk about the medio-lateral extent

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of accumulation of iron in the nigrostriatal

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distribution in the axial projection

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in the next vignette.

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Let's move on, shall we?

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Neuroradiology

MRI

Iron distrtibution

Brain

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