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Sympathetic noradrenergic before striatal dopaminergic denervation: relevance to Braak staging of synucleinopathy

2011; Springer Science+Business Media; Volume: 22; Issue: 1 Linguagem: Inglês

10.1007/s10286-011-0136-4

1619-1560

David S. Goldstein, Courtney Holmes, LaToya Sewell, Mee Yeong Park, Yehonatan Sharabi,

Neuroscience and Neuropharmacology Research

Braak’s staging concept of Lewy body disease pathogenesis is based on a spatiotemporal sequence of alpha-synuclein deposition, with autonomic nervous system involvement before synucleinopathy in substantia nigra neurons. A patient with primary chronic autonomic failure underwent biennial brain 6-[18F]DOPA and myocardial 6-[18F]dopamine scanning over 4 years. Low myocardial radioactivity indicated cardiac noradrenergic denervation that persisted. Striatal 6-[18F]DOPA-derived radioactivity initially was normal, 2 years later was decreased subtly, and by 4 years was clearly decreased, accompanied by dementia and parkinsonism. In this case, neuroimaging evidence of cardiac noradrenergic denervation and subsequent progressive striatal dopaminergic denervation fit with Braak staging.