PMC10372361_01
(A) Axial FLAIR imaging one year prior to presentation. Mild white matter changes and mild generalized atrophy. The MRI does not show midbrain atrophy or striatal abnormalities. (B) DaTscan with heterogenous striatal binding and partial loss of normal comma-shaped morphology bilaterally consistent with a presynaptic dopaminergic deficit.
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An MRI performed at age 64, 1 year prior to consultation, demonstrated only mild periventricular white matter changes and mild generalized atrophy (Fig. 1A).
Representative images of macroscopic and microscopic findings. (A-D) Macroscopic findings show moderate cortical atrophy over the dorsolateral frontal lobe. (B) No atrophy is observed in the brainstem and cerebellum. (C) The lateral ventricle is moderately enlarged. The posterior part of the putamen is preserved. (D) The size of midbrain, pons, and the superior cerebellar peduncle are preserved. (E) Immunohistochemistry with anti-phospho-tau antibody (CP13, from the late Peter Davies), anti-4-repeat tau antibody (RD4, Millipore, Temecula, CA), as well as Gallyas silver staining. CP13 and RD4 immunohistochemistry reveals numerous globular astrocytic inclusions in the motor cortex and inferior temporal cortex, which are slightly stained with Gallyas silver staining (arrows). In the white matter of the frontal and temporal lobes, many globular oligodendrocytic inclusions are observed. These are also positive with Gallyas silver staining (arrows).
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Macroscopic findings revealed moderate cortical atrophy over the dorsolateral frontal lobe, but no temporal lobe atrophy (Fig. 2A). The sagittal plane showed no atrophy in the brainstem or cerebellum (Fig. 2B). The lateral ventricle was moderately enlarged (Fig. 2C). The sections of brainstem and cerebellum were unremarkable (Fig. 2D).