title: Morning glory sign: a particular MR finding in progressive supranuclear palsy.
abstract: OBJECTIVE
  We have encountered a peculiar atrophic change in the midbrain in some patients with parkinsonian syndromes. We discovered these patients had vertical supranuclear gaze-palsy, an eye movement disorder. The purpose of this study was to elucidate whether this atrophic pattern of the midbrain (which we have termed morning glory sign) is related to the vertical eye movement disorder, in particular to progressive supranuclear palsy (PSP).
  
  
  METHODS
  We reviewed T2-weighted axial images obtained from 42 patients with parkinsonian syndromes, including five patients with PSP, 23 patients with Parkinson's disease, and 14 patients with multiple system atrophy (MSA). We focused on a specific atrophy of the midbrain, the morning glory sign, which is a concavity of the lateral margin of the tegmentum of the midbrain.
  
  
  RESULTS
  The morning glory sign was detected in four of the five patients with PSP and in one (striatonigral degeneration; SND) of the14 patients with MSA. All morning glory sign patients had vertical supranuclear gaze-palsy, as did the one PSP patient without the morning glory sign. Vertical supranuclear gaze-palsy was seen in no other patients (23 patients with Parkinson's disease and 13 patients with MSA) who lacked the morning glory sign.
  
  
  CONCLUSIONS
  Morphologically, the morning glory sign is believed to be related to vertical supranuclear gaze-palsy. This sign should be considered a useful clue when diagnosing PSP.
authors.affiliation: Department of Radiology, Ohshima Clinic, Yamagata, Japan. miadchi@beach.ocn.ne.jp
authors.forename: Michito
authors.initials: M
authors.lastname: Adachi
authors.forename: Toru
authors.initials: T
authors.lastname: Kawanami
authors.forename: Humi
authors.initials: H
authors.lastname: Ohshima
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sugai
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hosoya
mesh_terms: D000368:Aged; D001284:Atrophy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D013494:Supranuclear Palsy, Progressive / Q000473:pathology*