Rinsho Shinkeigaku (Clinical Neurology)

Case Report

An autopsy case of SCA2 with parkinsonian phenotype

Harumi S. Yomono, M.D., Ph.D.1), Hiroshi Kurisaki, M.D., Ph.D.1), Akira Hebisawa, M.D., Ph.D.2), Yoshio Sakiyama, M.D., Ph.D.3), Yuko Saito, M.D., Ph.D.4) and Shigeo Murayama, M.D., Ph.D.5)

1)Department of Neurology, National Hospital Organization Tokyo Hospital
2)Department of Pathology, National Hospital Organization Tokyo Hospital
3)Department of Neurology, Saitama Medical Center, Jichi Medical University
4)Department of Clinical Laboratory, National Center Hospital of Neurology and Psychiatry
5)Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology

This is the first autopsy case of SCA2 with parkinsonian phenotype. At the age of 46, the patient got symptoms of parkinsonism to which anti-parkinsonian drugs were effective. He had mosaic 38, 40 CAG repeat expansions on chromosome 12q23-24, being diagnosed as SCA2, and his mother and his son also had CAG expansions on the same locus. In addition to parkinsonism, he also exhibited autonomic disturbance, dementia, and mild cerebellar ataxia. Brain images revealed severe atrophy of pons and medulla oblongata, resembling MSA-C. HVA and 5-HIAA were reduced in the cerebrospinal fluid, and the heart-mediastinum (H/M) ratio in myocardial 123I-MIBG cintigram was decreased, which suggested Lewy body pathology. He died at the age of 75 and the autopsy revealed atrophy of the olivo-ponto-cerebellar (OPC) system and substantia nigra which was compatible to SCA2, although the OPC system atrophy was less severe than formerly reported SCA2 cases. The degrees of atrophy of the OPC system and substantia nigra might explain the predominancy of clinical symptoms. Anti-1C2 positive inclusions in the pontine nuclei, inferior olive nuclei, cerebellum and substantia nigra confirmed a polyglutamine disease. In addition, there were the anti-phosphorylated α-synuclein positive, Lewy body related pathological changes in the substantia nigra, the locus ceruleus, the dorsal motor nuclei of vagus, and the sympathetic nerve in the myocardium. Major genetic abnormalities related to Parkinson disease were not detected. As another case of SCA2 with Lewy body pathology was reported in Japan, the coexistence of SCA2 and Lewy body pathology may not be accidental. Since myocardial MIBG scincigram can predict Lewy body pathology, we should seek more clinical cases of SCA2 with Lewy body pathology.
Full Text of this Article in Japanese PDF (1741K)

(CLINICA NEUROL, 50: 156|162, 2010)
key words: SCA2, parkinsonism, Lewy body pathology

(Received: 10-Jul-09)