5. Brain Iron
Iron is a key trace metal relating to brain function. The major
functions in which iron performs a role include:
Oxidative phosphorylation
Dopamine synthesis and degradation
Hydroxyl free-radical formation
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6. Brain Iron
A. Neurodegenerative
i. Parkinson’s Plus Putamen
a. Striatonigral Degeneration
b. Shy-Drager
c. Olivopontocerebellar Atrophy
ii. Hallervorden-Spatz Globus Pallidus
(+ Red Nucleus / Nigra)
iii.Alzheimer’s Cortical
B. Metabolic
i. Hypothyroidism Generalized
ii. [Hepatic failure exhibits signal hyperintensity in the globus pallidus on T1 images
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7. Brain Iron
C. Hemorrhage
Intracerebral Hematoma Site of Bleed
Hemorrhagic Infarction Gyral
Vascular Malformation Interstices / Margin
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8. Brain Iron
D. Demyelination
i. Multiple Sclerosis (severe) Thalamus /Putamen
ii. Microangiopathic
Leukoencephalopathy Putamen
iii. Radiation injury White Matter/ Putamen
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9. INVESTIGATIONS FOR PRIMARY MOVEMENT
DISORDERS
Imaging (MRI)
Exclusion of Wilson <50)
Genentic testing
Routine blood wing Biochemistry
Syphilis
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10. Investigation in Secondary Movement
Disorders
GENERAL PLAN
Extent of nervous system involvement
Psychometric evaluation
EEG (epilepti form discharges)
ENMG (peripheral neruropathy)
EMG and VEP
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11. Role of CT
CONDITIONS THAT MAY PRODUCE WHITE MATTER
CHANGE ON BRAIN CT OR MRI AND WHICH MAY CAUSE
MOVEMENT DISORDERS.
Alexander’s disease
Krabbe’s disease
Polycystic lipomembranous osteodyplasia
Adeno – myelo – Leukodystrophy
Metachromatic leukodystrophy
Mitrochondrial diorders.
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12. DEGENERATIVE AND SYSTEMIC DISORDERS
Polyeystic lipomembraneous Hand X-rays, skin biopsy
Degeneration
Hallervorden Spatz disease Brain MRI
Pallidal degenerations Brain MRI
Alzheimer’s disease Brain MRI
Multi – infarct state Brain MRI
Binswanger’s subcortical arteriosclerotic Brain MRI
Encephalopathy
Normal pressure hydrocephalus Brain MRI
Dementia pugilistica Brain MRI
Calcification of the basal ganglia Brain CT and MRI
Cerebral anoxia
(Co and cyanide poisoning) Brain MRI
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13. Wilson’s Disease
3 movement disorders
Akinetic-rigid syndrome resembling Parkinsonism
Dystonic syndrome
Postural and intentional tremor
Clinical
Tremor, rigidity, gait difficulty
Bulbar signs: indistinct speech, dysphagia
Hepatic encephalopathy
Anemia (10%)
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15. Wilson’s Disease
MR
Altered GM and WM signal intensities
Atrophy of caudate head, brain stem
Cerebral and cerebellar atrophy
MR: 3 patterns
T1 PD/T2
Variable increased
increased variable
variable decreased
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16. Wilson’s Disease
Type I
Putamen, GP, thalamus
Caudate, claustrum, subthalamus
Red nucleus, substantia nigra
Dentate
Type II
Globus pallidus
Rarely putamen, caudate
Type III
Basalganglia
Thalamus
Dentate nucleus
Superior colliculus
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20. Hemochromatosis
MR
hypointensity of basal ganglia, thalami
central white matter
adenohypophysis
choroids plexus
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21. Degenerative Disorders
Diseases of the Substantia Nigra
Parkinson’s disease
Progressive supranuclear palsy
Straitonigral degeneration
Hallervorden – Spatz disease
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22. Parkinson’s Disease
MR
Diminished width of pars compacta
Normal putamina
MR-guided Pharmacotherapy
Intracerebroventricular drug delivery
Parenchymal drug delivery
Huge population of new patients with neurodegenerative
disorders potentially amenable to targeted
pharmacotherapy
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23. Parkinson’s Disease
Progressive Supranuclear Palsy
Pathology
Atrophy of mesencephalon
Periaqueductal gliosis and neurofibrillary tangles
MR
Subtle enlargement of aqueduct
Subtle atrophy of periaqueductal gray
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24. Parkinson’s Disease
MR
Diminished width of pars compacta
Hypointense dorsolateral putamina
Hallervorden – Spatz Disease
Gradual limb stiffness
Dysarthria, dementia
50% exhibit choreiform or athetosis
marked symmetric T2-shortening
globipallidi
+ pars reticularis
eye of the tiger appearance
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25. Differentiation
Signal Hypointensity T2 <Putamen>
Parkinson’s Plus (Multiple System Atrophy)
Hypothyroidism
Signal Hyperintensity T2 <Putamen>
Wilson’s
Familial Striatal Degeneration
Creutzfeldt jakob
Anoxia
Leigh’s
Ophthalmoplegia Plus
Pallidoluysian Degeneration
Signal Hyperintensity T1 <Globus Pallidus>
Hepatic insufficiency
Anoxia (petechial hemorrhage)
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