Abstract
BackgroundSecondary pallidonigral transneuronal degeneration after a remote primary cerebral infarct can mimic recurrent stroke at clinical presentation. We describe a patient with secondary pallidonigral degeneration following a previous putaminal infarct, which was diagnosed through diffusion-weighted (DWI) and T2-weighted imaging (T2WI).Case presentationA 64-year-old man complained of an acute relapse of right-lower-limb weakness following a cerebral infarction 2 months before presentation. Recurrent cerebral stroke was initially diagnosed in the emergency room. DWI of the brain revealed a subacute to chronic infarct in the left putamen and new acute cytotoxic edema in the left substantia nigra (SN) and globus pallidus while T2WI also showed hyperintensity in the same regions. The SN was outside the aforementioned middle cerebral arterial territory, which includes the putamen. These findings are compatible with the diagnosis of acute pallidonigral injury secondary to striatal infarction. The patient had fully recovered from his right-lower-limb weakness after 1 month.ConclusionsSecondary pallidonigral degeneration may mimic recurrent stroke. DWI along with T2WI facilitates elucidation of this clinicopathological entity, and thus unnecessary treatment can be avoided.
Highlights
Secondary pallidonigral transneuronal degeneration after a remote primary cerebral infarct can mimic recurrent stroke at clinical presentation
Secondary pallidonigral degeneration is a rare clinicopathological entity in which excitotoxicity occurs in the neurons of the globus pallidus and substantia nigra (SN) following transneuronal degeneration (TND) caused by prior upstream brain injury, usually in the putamen
MR scans of the brain (GE healthcare, Signa HDxt 1.5 T) were obtained on the same day; the scans showed an old infarct in the left putamen with hyperintensity on fluid-attenuated inversion recovery (FLAIR), T2-weighted imaging (T2WI), and the apparent diffusion coefficient (ADC) map (Fig. 1), which was consistent with the patient’s
Summary
Secondary pallidonigral degeneration may mimic recurrent stroke. DWI along with T2WI facilitates elucidation of this clinicopathological entity, and unnecessary treatment can be avoided.
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