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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 21B MSA (Case 21) a syn A

A pontine section shows a cytoplasmic pSYN immunoreactive pontine deposit. (pSYN IHC) ---- Not shown: Immunohistochemistry for alpha-synuclein and Gallyas stains demonstrate numerous GCI in the deep cerebellar white matter. Sections of the midbrain show loss of pigmented neurons of the substantia nigra accompanied by astrocytosis and extraneuronal pigment, both free and in macrophages. Lewy bodies are not seen. Neurons in the pontine nuclei of the basis pontis are significantly decreased in number and are accompanied by numerous reactive astrocytes. Gallyas and alpha-synuclein stains demonstrate large numbers of GCI in the basis pontis as well as rare intranuclear and cytoplasmic filamentous inclusions in pontine neurons. The medulla shows increased numbers of astrocytes especially in the region of the inferior cerebellar peduncle/cochlear/vestibular nuclei. Neurons are diminished in both inferior olivary nuclei. Sections of the spinal cord show questionable, patchy neuron loss and astrocytosis involving the anterior horn. Neurons composing the intermediolateral nuclei in the thoracic spinal cord are visualized and do not appear abnormal. ---- Neuro Final Diagnosis: Multiple System Atrophy

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