By Perkin G David

Any dialogue of the scientific features of Parkinson's disorder needs to take note of the inaccuracies of medical analysis. In a successive sequence of a hundred sufferers with a medical prognosis of Parkinson's affliction, in basic terms seventy six fulfilled the standards for prognosis at autopsy exam. makes an attempt to tighten the diagnostic standards result in elevated specificity yet with lowered sensitivity.In An Atlas of Parkinson's sickness and comparable issues Dr. David Perkin has compiled a chain of photos highlighting quite a few points of Parkinson's illness and similar motor issues. The ebook offers an invaluable pattern of scientific, investigative (CT, MRI, and puppy) and pathological photos with succinct descriptive textual content of the problems featured. nearly one-third of the cloth during this e-book is pathological, incorporating either macroscopic and microscopic sections. an additional area of the fabric is represented through imaging, largely magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning. the world of stream issues has been really fruitful for puppy scanning, which offers, with the improvement of particular ligands for many of the receptor websites, to extra extend knowing of the pathophysiological mechanisms of the stream problems. Reflecting the top criteria medical images and imaging besides the celebrated author's specialist wisdom of the topic, Dr. Perkin's An Atlas of Parkinson's disorder and comparable issues is the definitive and crucial scientific reference in its box.

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Neurology in Clinical Practice, 1996 (see page 31) MC/SMA/PMC PUTAMEN D2 MC/SMA/PMC PUTAMEN D1 D2 D1 direct pathway indirect pathway SNc SNc VLo VApc/mc CM GPe STN GPe VLo VApc/mc CM STN GPi/SNr Brain stem Spinal cord ©2004 CRC Press LLC GPi/SNr Figure 2 Connections of striatal output neurons in controls (left) and in rats with 6-0H dopamine lesions of the nigrostriatal dopamine system (right). MC, motor cortex; SMA, supplementary motor area; PMC, premotor cortex; D1 / D2, D1 / D2 dopamine receptor systems; SNc, substantia nigra pars compacta; SNr, substantia nigra pars reticulata; GPe / GPi, external / internal portions of globus pallidus; STN, subthalamic nucleus; VLo, ventral lateral, pars oralis, nucleus of thalamus; VApc / mc, ventral anterior, pars parvocellularis / pars magnocellularis, nucleus of thalamus; CM, centromedian nucleus of thalamus Figure 3 Horizontal sections of midbrain (upper) and pons (lower) in idiopathic Parkinson's disease of 10 years' duration show pallor in the substantia nigra (arrowed) and locus ceruleus (arrowed), respectively Figure 4 Histology of normal substantia nigra, which is well-populated with nerve cells immunoreactive for tyrosine hydroxylase (immunostained for tyrosine hydroxylase) ©2004 CRC Press LLC Figure 5 Histology of substantia nigra in idiopathic Parkinson's disease of 12 years' duration showing depletion of tyrosine hydroxylase-containing nerve cells (immunostained for tyrosine hydroxylase) Figure 6 Histological views of a Lewy body in the substantia nigra pars compacta stained with H & E (left) and with a modified Bielschowsky stain (right) ©2004 CRC Press LLC Patients (n ) 20 Female 18 Male 16 14 12 10 8 6 4 2 0 36 – 40 41 – 45 46 – 50 51 – 55 56 – 60 61 – 65 66 – 70 71 – 75 76 – 80 81 – 85 Age (years) Figure 7 Age and gender distribution at the time of diagnosis in a small series of Parkinsonian patients Figure 8 Micrographia in Parkinson's disease: The script is progressively reduced in size ©2004 CRC Press LLC Figure 9 Characteristic facial appearance in Parkinson's disease Figure 10 Posture of a patient with early Parkinson's disease ©2004 CRC Press LLC Figure 11 Posture of a patient with later-stage Parkinson's disease ©2004 CRC Press LLC Figure 12 As this patient repetitively clenches and unclenches his fists, a paucity of movement is apparent in his left hand Figure 13 Power-spectrum (upper) and accelerometer (lower) tracings taken from a patient with Parkinsonian tremor.

COMT, catechol O-methyltransferase; +, by stimulation; –, by inhibition ©2004 CRC Press LLC Figure 17 Dystonic posturing secondary to dopa therapy. There is hyperextension of the left big toe Figure 18 Dystonic posturing of the right thumb and little finger (on the left) secondary to dopa therapy ©2004 CRC Press LLC Figure 19 CT of a patient with previous bilateral thalamotomies (arrowed) performed for control of a Parkinsonian tremor Figure 20 Fluorodopa-uptake studies in a patient following dopaminergic grafting ©2004 CRC Press LLC Figure 21 Coronal brain section showing abnormal white matter (white arrow) above the ventricular roof with relative preservation of subcortical white matter (U fibers; black arrow) Figure 22 Histology showing parietal white matter at the bottom of the cortex, a relatively preserved (but not quite normal) arcuate zone (white arrow), and rarefied pale-staining deep white matter, containing thick-walled arteriosclerotic blood vessels lying in dilated and fibrotic perivascular spaces (black arrow)(Luxol fast blue–H & E) ©2004 CRC Press LLC Figure 23 Histology showing a lacunar infarct (pale area) with an irregular cavity lined by reactive cells (astrocytes and macrophages).

Evidence of Purkinje cell degeneration (right) with formation of axon torpedoes (white arrow) is seen in the molecular layer (H & Es) ©2004 CRC Press LLC Figure 40 Histological sections showing examples of oligodendroglial cytoplasmic inclusions in multiple system atrophy (H & Es) ©2004 CRC Press LLC Figure 41 Sagittal T1-weighted MRI showing pontine (black arrow) and cerebellar (white arrow) atrophy in a patient with olivopontocerebellar atrophy ©2004 CRC Press LLC Figure 42 T2-weighted MRI (upper) shows hyperintensity of the middle cerebellar peduncles and the cerebellum.

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