Path Labs - Brain & Behaviour Block - Movement Disorder
Department of Pathology & Laboratory Medicine
Case 1
This 68 year old man had a 12 year history of movement abnormality which began with a resting tremor and progressed to include a shuffling gait, decreased facial expression, rigidity and postural instability. He had been treated with L-dopa and although his symptoms initially improved, the last few years of his life were marked by fluctuations in motor function.
Q1. What is the diagnosis? What other diseases could produce similar symptoms?
Q2. What is the gross abnormality shown in Figure 1-1? (left = section of midbrain from patient, right = normal control)
Q3. What microscopic change corresponds with the gross findings? How does the patient's treatment relate to that microscopic change?
Q4. What specific pathologic abnormality is illustrated in Figure 1-2 and Figure 1-3?
Q5. If this patient had become demented late in life, what additional neuropathology might be found in the cerebral cortex?
Case 2
This 55 year old unemployed man had a history of chronic alcohol abuse and frequent falls. He had developed an unsteady, wide-based gait with some incoordination of his legs and instability of his trunk, over several years. He was found by his landlord, lying unresponsive in his room.
Figure 2-1 shows a sagittal section through the midline cerebellum from this patient.
Q1. What gross abnormality is demonstrated?
Q2. What are the corresponding microscopic changes illustrated in Figure 2-2? (top = alcoholic patient, bottom normal control).
Q3. How are these changes related to the history of chronic alcoholism?
Q4. What is the normal function of this part of the cerebellum?
Case 3
A 45 year old man died from the complications of aspiration pneumonia following a 5 year history of rapidly progressive weakness. Preterminally he was bedridden and unable to move his arms or legs. Eye movements were unaffected.
Q1. Describe what abnormality you see in each of the following figures:
Figure 3-1: Spinal cord. What is the difference between the anterior and posterior (on left side of slide) nerve roots?
Figure 3-2: Section of spinal cord.
Figure 3-3: Anterior horn of spinal cord.
Figure 3-4: Skeletal muscle.
Q2. List your differential diagnosis. What disease(s) could account for all of these changes?
Q3. Would neurologic examination have revealed signs of an upper or lower motor neuron problem, or both?
Case 4
A 39 year old man with a 5 year history of a progressive disorder characterised by non rhythmic movements of the limbs committed suicide.
Q1. Refer to the following figures and describe the abnormalities and list your differential diagnosis.
Figure 4-1: This is a coronal section of his brain.
Figure 4-2 and figure 4-3: Closer view of the basal ganglia and lateral ventricle.
His father died from pneumonia aged 67 years. He had developed similiar symptoms in his early 50's, followed by rigidity, dystonia and dementia.
Q2. What are the genetics of this disease?
Q3. If this disease is hereditary, why did the son present at an earlier age than the father?