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

• Koo MW
• Kim YK
• Ku KM
• Park WW
• Minn YK

• KMID: 2287584
• DOI: http://doi.org/10.3988/jcn.2012.8.4.308

Abstract

BACKGROUND
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.
CONCLUSIONS
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.

Keyword

transsynaptic; degeneration; globus pallidus; substantia nigra

MeSH Terms

Brain
Caudate Nucleus
Cell Death
Emergencies
Female
Globus Pallidus
Humans
Magnetic Resonance Imaging
Neurons
Oxygen
Putamen
Stroke
Substantia Nigra
Oxygen

Figure

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  Fig. 1 Case 1. A: Diffusion-weighted magnetic resonance imaging scan of the brain on day 1, showing high-intensity signals in the caudate nucleus, putamen, and temporooccipital cortex on both sides of the brain. B: Follow-up diffusion-weighted magnetic resonance imaging scan performed 10 days after admission, showing newly developed high-intensity signals in the substantia nigra and globus pallidus (arrows).

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  Fig. 2 Case 2. A: Diffusion-weighted brain magnetic resonance imaging scan performed on day 2 after admission, showing high-intensity signal lesions in the caudate nucleus and putamen. B: Newly developed high-intensity signals in the right substantia nigra and globus pallidus were observed on a diffusion-weighted magnetic resonance imaging image obtained 4 days after admission.

Reference

1. Zhao F, Kuroiwa T, Miyasaka N, Nagaoka T, Nakane M, Tamura A, et al. Ultrastructural and MRI study of the substantia nigra evolving exofocal post-ischemic neuronal death in the rat. Neuropathology. 2002. 22:91–105.

2. Zhao F, Kuroiwa T, Miyasaka N, Nagaoka T, Nakane M, Tamura A, et al. Characteristic changes in T(2)-value, apparent diffusion coefficient, and ultrastructure of substantia nigra evolving exofocal postischemic neuronal death in rats. Brain Res. 2001. 895:238–244.

3. Nakane M, Teraoka A, Asato R, Tamura A. Degeneration of the ipsilateral substantia nigra following cerebral infarction in the striatum. Stroke. 1992. 23:328–332.

4. Nambu A. Globus pallidus internal segment. Prog Brain Res. 2007. 160:135–150.

5. Kinoshita T, Sugihara S, Matsusue E, Fujii S, Ametani M, Ogawa T. Pallidoreticular damage in acute carbon monoxide poisoning: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol. 2005. 26:1845–1848.

6. Gutierrez LG, Rovira A, Portela LA, Leite Cda C, Lucato LT. CT and MR in non-neonatal hypoxic-ischemic encephalopathy: radiological findings with pathophysiological correlations. Neuroradiology. 2010. 52:949–976.

7. Kita H, Tachibana Y, Nambu A, Chiken S. Balance of monosynaptic excitatory and disynaptic inhibitory responses of the globus pallidus induced after stimulation of the subthalamic nucleus in the monkey. J Neurosci. 2005. 25:8611–8619.

8. Tachibana Y, Kita H, Chiken S, Takada M, Nambu A. Motor cortical control of internal pallidal activity through glutamatergic and GAB-Aergic inputs in awake monkeys. Eur J Neurosci. 2008. 27:238–253.

9. Fève AP, Fénelon G, Wallays C, Rémy P, Guillard A. Axial motor disturbances after hypoxic lesions of the globus pallidus. Mov Disord. 1993. 8:321–326.

10. Gerfen CR. Molecular effects of dopamine on striatal-projection pathways. Trends Neurosci. 2000. 23:S64–S70.