By Perkin G David
Any dialogue of the scientific features of Parkinson's ailment needs to take note of the inaccuracies of medical analysis. In a successive sequence of a hundred sufferers with a medical analysis of Parkinson's sickness, purely seventy six fulfilled the factors for analysis at autopsy exam. makes an attempt to tighten the diagnostic standards bring about elevated specificity yet with lowered sensitivity.In An Atlas of Parkinson's sickness and similar problems Dr. David Perkin has compiled a chain of photos highlighting numerous elements of Parkinson's sickness and comparable motor issues. The publication offers an invaluable pattern of medical, investigative (CT, MRI, and puppy) and pathological photos with succinct descriptive textual content of the issues featured. nearly one-third of the fabric during this e-book is pathological, incorporating either macroscopic and microscopic sections. one other region of the fabric is represented through imaging, mostly magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning. the realm of circulate issues has been quite fruitful for puppy scanning, which can provide, with the improvement of particular ligands for a few of the receptor websites, to extra extend realizing of the pathophysiological mechanisms of the flow issues. Reflecting the top criteria medical images and imaging in addition to the prestigious author's professional 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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Additional resources for An Atlas of Parkinson's Disease and Related Disorders (Encyclopedia of Visual Medicine Series)
Debris and a few vascular channels can be seen (Luxol fast blue–H & E) Figure 24 CT of a patient with a Parkinsonian syndrome shows multiple lacunar infarcts ©2004 CRC Press LLC Figure 25 T1-weighted MRI showing multiple small hypointense foci in the putamen and caudate nuclei bilaterally. The patient had presented with a Parkinsonian state with, eventually, predominant axial features Figure 26 Coronal brain section (same patient as in Figure 25) showing numerous small lacunes in the heads of both caudate nuclei and in the anterior part of the putamen ©2004 CRC Press LLC Figure 27 Histological sections from Parkinson's disease with dementia showing cortical Lewy bodies stained with ubiquitin (immunochemistry preparation, left; silver impregnation, right) Figure 28 Histology showing a subthalamic neuron containing a globose neurofibrillary tangle in progressive supranuclear palsy (Bielschowsky silver impregnation) ©2004 CRC Press LLC A B C D Figure 29 In this patient with progressive supranuclear palsy, upward (A) and lateral gaze (B and C) are preserved whereas down gaze (D) is impaired ©2004 CRC Press LLC Figure 30 Attempted down gaze (left) shows improvement with the doll's-head maneuver (right) in this patient with progressive supranuclear palsy Figure 31 Sagittal T1-weighted MRI showing midbrain atrophy (arrowed) in progressive supranuclear palsy ©2004 CRC Press LLC Figure 32 11C-raclopride binding in a normal subject (left) compared with that in Parkinson's disease (middle) and in progressive supranuclear palsy (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).
An Atlas of Parkinson's Disease and Related Disorders (Encyclopedia of Visual Medicine Series) by Perkin G David