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Washington University Experience | NEURODEGENERATION | Multiple Systems Atrophy (MSA) | 7G MSA (Case 7) N7 H&E 1.jpg
Numerous GCI are found in the pons. The locus ceruleus shows mild neuronal loss and gliosis with numerous pigment-laden macrophages. (H&E) ---- Not shown: Immunohistochemical stain for phosphorylated α-synuclein shows numerous positive glial cells in both the crossing and ascending white matter tracts of the basis pontis. Rare neurons from the pontine nuclei show cytoplasmic synuclein inclusions. The locus coeruleus and other tegmental nuclei show glial and occasional neuronal cytoplasmic inclusions. ---- Neuro Final Diagnosis: Multiple systems atrophy (Shy-Drager syndrome) ---- Neuro Diagnosis Comment: The most significant findings on postmortem examination of this patient's central and peripheral nervous system were extensive neurodegeneration of the posterolateral putamen and the substantia nigra accompanied by a high burden of pathologic alpha-synuclein accumulation in glia. The presence of numerous alpha-synuclein-positive glial inclusions in the spinal cord and in the vicinity of the intermediolateral cell column suggest that these structures were affected and could have led to the autonomic dysfunction this patient experienced later in the disease course.
