title: Asymmetrical temporal lobe atrophy with massive neuronal inclusions in multiple system atrophy.
abstract: This report concerns a rare association of asymmetrical temporal lobe atrophy with multiple system atrophy (MSA). A 53-year-old Japanese woman developed cerebellar ataxia and parkinsonism and was diagnosed as olivopontocerebellar atrophy (OPCA). This patient showed forgetfulness and subsequent disorientation even in the early stage of the disease. She fell into a decorticate state at the age of 64, and died a year later. The autopsy showed MSA with asymmetrical atrophy of temporal lobes, intraneuronal globular inclusions mostly confined to the hippocampus, amygdaloid nucleus, and most abundant in the granule cells in the dentate fascia. These inclusions were intensely argyrophilic and expressed marked immunoreactivity to ubiquitin, but not to neurofilament (NF), tau and paired helical filaments (PHF). Ultrastructurally, they were composed of scattered short filamentous structures of 15 to 30 nm in diameter, ribosome-like granules, mitochondria and lipofuscin. The lack of immunoreactivity against tau, NF and PHF suggests that the inclusions are distinct from Pick bodies. To our knowledge, MSA in association with asymmetrical temporal lobe atrophy with the present neuronal inclusions has not been reported. This case is distinct from MSA combined with atypical Pick's disease in the distribution and immunohistochemical properties of neuronal inclusions, and may present a new variant of MSA since the neuronal inclusions are similar, in many respects, to those of neuronal inclusions reported in MSA. Globular inclusions are also discussed in variants of Pick's disease, amyotrophic lateral sclerosis and Alzheimer's disease.
authors.affiliation: Department of Neurology and Psychiatry, Numazu Central Hospital, Nakasecho 24-1, Numazu, 410-8575, Shizuoka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shibuya
authors.forename: H
authors.initials: H
authors.lastname: Nagatomo
authors.forename: K
authors.initials: K
authors.lastname: Iwabuchi
authors.forename: M
authors.initials: M
authors.lastname: Inoue
authors.forename: S
authors.initials: S
authors.lastname: Yagishita
authors.forename: Y
authors.initials: Y
authors.lastname: Itoh
mesh_terms: D001284:Atrophy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D002479:Inclusion Bodies / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D009410:Nerve Degeneration / Q000378:metabolism / Q000473:pathology*; D009474:Neurons / Q000378:metabolism / Q000473:pathology*; D011859:Radiography; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology*