case_images: PMC5775520_01
case_images: The rapid progress of brain atrophy in the MSA patient after developing hypoxic encephalopathy axial CT images of the patient acquired in September 2015 (A-E) and in July 2016 (F-J) are shown. MSA, multiple system atrophy; CT, computed tomography.
case_images: fneur-08-00754-g001.jpg
case_images: PMC5775520_01_fneur-08-00754-g001.jpg
case_images: F1
case_images: Computed tomography assessment showed no apparent atrophy in the cortical region or brainstem in September 2015 (Figure 1). August 2016, respectively (Figures 1-3). Atrophy was observed in the midbrain, caudal pons, and striata on both sides ("hyperintense lateral putaminal rim") (Figures 2 and 3), which strongly indicated MSA.
case_images: Severe atrophy in the MSA patient's brain observed in August 2016 Gadolinium-enhanced MRI T2 images (TR: 4,800 ms, TE: 105 ms) (A-E), fluid-attenuated inversion recovery images (TR 10,000 ms, TE 120 ms) (F-J), and diffusion-weighted imaging images (TR 5,400 ms, TE 100 ms) (K-O) of the patient's brain in August 2016 are shown. Arrows in (C) indicate dorsolateral regions of atrophy ("hyperintense lateral putaminal rim"). MSA, multiple system atrophy; MRI, magnetic resonance imaging.
case_images: fneur-08-00754-g002.jpg
case_images: PMC5775520_01_fneur-08-00754-g002.jpg
case_images: F2
case_images: August 2016, respectively (Figures 1-3). Atrophy was observed in the midbrain, caudal pons, and striata on both sides ("hyperintense lateral putaminal rim") (Figures 2 and 3), which strongly indicated MSA.
case_images: MRI coronal (A) and sagittal (B) T1 images (TR 540 ms, TE 15 ms) of the MSA patient in August 2016. Note the atrophy in the caudal pons. The midbrain and cerebellum are atrophic. (C) Areas of the midbrain (M) and pons (P) are shown. (D) The width of the superior cerebellar peduncles (segments) is shown. (E) The width of the middle cerebellar peduncles (segments) is shown. MSA, multiple system atrophy; MRI, magnetic resonance imaging.
case_images: fneur-08-00754-g003.jpg
case_images: PMC5775520_01_fneur-08-00754-g003.jpg
case_images: F3
case_images: August 2016, respectively (Figures 1-3). Atrophy was observed in the midbrain, caudal pons, and striata on both sides ("hyperintense lateral putaminal rim") (Figures 2 and 3), which strongly indicated MSA. Measurement of the T1-weighted mid-sagittal image and T2-weighted axial images showed that the midbrain area and pons area were 75.3 and 321.2 mm2, respectively, and the mean widths of the superior cerebellar peduncles and middle cerebellar peduncles were 3.38 and 11.25 mm, respectively, as measured in the same manner as described in a previous study (Figures 3C-E).
case_images: Severe atrophy in the white and gray matter of the MSA patient. Z-score maps of the white matter (A-C) and gray matter (D-F) of the MSA patient are shown. The brain image of the patient is compared with that of individuals without neurodegenerative diseases or dementia. The color scale for the z-score is shown on the bottom right. Colored areas indicating a z-score of >2 are overlaid as regions of significant atrophy. Coronal (A,D), sagittal (B,E), and axial (C,F) sections by magnetic resonance imaging (MRI) are presented on a standardized MRI template. Regions with a z-score of >6 exist widely in the patient's brain, regardless of whether the region belongs to the white or gray matter. [Regions inside the purple polygons are medial temporal lobes, because the initial aim of the voxel-based specific regional analysis system for Alzheimer's disease software creators was estimation of the atrophy rate of the area ]. MSA, multiple system atrophy.
case_images: fneur-08-00754-g004.jpg
case_images: PMC5775520_01_fneur-08-00754-g004.jpg
case_images: F4
case_images: Use of the voxel-based specific regional analysis system for Alzheimer's disease software according to the method used in previous studies on the same regions showed that the white and gray matter atrophy values were 77.36 and 80.49%, respectively, with a z-score >2 in October 2016 (Figure 4).