title: Pyramidal tract degeneration in multiple system atrophy: the relevance of magnetization transfer imaging.
abstract: The clinical features of multiple system atrophy (MSA) include four domains: autonomic failure/urinary dysfunction, Parkinsonism, cerebellar ataxia, and corticospinal tract dysfunction. Although the diagnosis of definite MSA requires pathological confirmation, magnetic resonance imaging (MRI) studies have been shown to contribute to the diagnosis of MSA. Although pyramidal tract dysfunction is frequent in MSA patients, signs of pyramidal tract involvement are controversially demonstrated by MRI. We evaluated the pyramidal involvement in 10 patients (7 women) with clinically probable MSA, detecting the presence of spasticity, hyperreflexia, and Babinski sign, as well as demonstrating degeneration of the pyramidal tract and primary motor cortex by MRI in all of them. Our article also discusses key radiological features of this syndrome. In MSA, pyramidal tract involvement seems to be more frequent than previously thought, and the clinicoradiological correlation between pyramidal tract dysfunction and degeneration may contribute to the understanding of the clinical hallmarks of MSA. MRI may also add information regarding the differential diagnosis of this syndrome.
authors.affiliation: Centro de Medicina Diagnóstica Fleury, Setor de Neuroradiologia, São Paulo, Brazil. antonio.rocha@fleury.com.br
authors.forename: Antonio José
authors.initials: AJ
authors.lastname: da Rocha
authors.forename: Antonio Carlos Martins
authors.initials: AC
authors.lastname: Maia
authors.forename: Carlos Jorge
authors.initials: CJ
authors.lastname: da Silva
authors.forename: Flávio Túlio
authors.initials: FT
authors.lastname: Braga
authors.forename: Nelson Paes Diniz Fortes
authors.initials: NP
authors.lastname: Ferreira
authors.forename: Orlando Graziani Povoas
authors.initials: OG
authors.lastname: Barsottini
authors.forename: Henrique Ballalai
authors.initials: HB
authors.lastname: Ferraz
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D009410:Nerve Degeneration / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D010302:Parkinson Disease, Secondary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011712:Pyramidal Tracts / Q000473:pathology*; D012021:Reflex, Abnormal / Q000502:physiology; D012720:Severity of Illness Index