J Clin Neurol.  2012 Dec;8(4):308-310. 10.3988/jcn.2012.8.4.308.

Exofocal Anterograde Transsynaptic Neuronal Death in the Globus Pallidus: Two Case Reports

  • 1Department of Neurology, Hallym University College of Medicine, Seoul, Korea. yangki2@unitel.co.kr


Exofocal neuronal death in the substantia nigra (SN) is a well-known form of anterograde transsynaptic cell death. Exofocal neuronal death could theoretically also occur in the globus pallidus (GP) after striatal injury. CASE REPORT: Case 1. A 70-year-old woman visited the emergency room because of decreased mentality. On admission, blood-gas analysis indicated that her oxygen tension was 69.1 mm Hg. The caudate nucleus, putamen, and temporooccipital cortex on both sides of the brain exhibited high-intensity diffusion-weighted magnetic resonance imaging (MRI) signals. At 10 days after admission, new high-intensity signals had developed in the SN and GP on both sides. Case 2. A 48-year-old man visited the emergency room because of right-sided weakness. Lesions were noted in the left caudate nucleus and putamen. At 4 days after admission, newly developed high-intensity MRI signals were observed in the left SN and GP.
Exofocal neuronal death can occur in the GP as well as in the SN; these findings need to be clearly distinguished from those of recurrent ischemic injuries, such as recurrent stroke.


transsynaptic; degeneration; globus pallidus; substantia nigra
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