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Yoshida K, Adachi T, Suzuki Y, Sakuwa M, Fukuda H, Hasegawa M, Adachi Y, Miura H, Hanajima R. Corticobasal degeneration with visual hallucination as an initial symptom: A case report. Neuropathology 2024; 44:298-303. [PMID: 38291581 DOI: 10.1111/neup.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
Although the initial symptoms of corticobasal degeneration (CBD) are varied, psychiatric symptoms are uncommon. Here, we report the autopsy findings of a patient with early CBD who presented with hallucinations. A 68-year-old man developed memory loss and visions of bears and insects. Because of slow vertical eye movement, postural instability, and levodopa-unresponsive parkinsonism, the patient initially was clinically diagnosed with progressive supranuclear palsy. He died of a urinary tract infection 11 months after the onset of the disease. Histopathological examination revealed neuronal loss and gliosis, which were severe in the substantia nigra and moderate in the globus pallidus and subthalamic nucleus. Astrocytic plaques were scattered throughout the amygdala and premotor cortex. The superficial cortical layers lacked ballooned neurons and spongiosis, and tau deposition was greater in glia than in neurons. The amygdala contained a moderate number of argyrophilic grains and pretangles. Western blot analysis showed a 37-kDa band among the low-molecular-weight tau fragments. Because the CBD pathology was mild, we attributed the patient's visual hallucinations to the marked argyrophilic grain pathology. CBD can occur with psychiatric symptoms, including visual hallucinations, and argyrophilic grain pathology may be associated with psychiatric symptoms.
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Affiliation(s)
- Kentaro Yoshida
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
- Department of Neurology, Matsue Red Cross Hospital, Matsue, Japan
| | - Tadashi Adachi
- Division of Neuropathology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuki Suzuki
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Mayuko Sakuwa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroki Fukuda
- Department of Neurology, Matsue Red Cross Hospital, Matsue, Japan
| | - Masato Hasegawa
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yoshiki Adachi
- Department of Neurology, National Hospital Organization Matsue Medical Center, Matsue, Japan
| | - Hiroshi Miura
- Department of Pathology, Matsue Red Cross Hospital, Matsue, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Horimoto Y, Sato C, Suzuki A, Inagaki A, Tajima T, Hibino H, Inagaki H. Frontotemporal lobar degeneration in the "Annual of the Pathological Autopsy Cases in Japan". J Neurol 2024:10.1007/s00415-024-12528-5. [PMID: 38909120 DOI: 10.1007/s00415-024-12528-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Good accuracy for the clinical diagnosis of frontotemporal lobar degeneration (FTLD) by specialists in an early onset dementia clinic has been reported. OBJECTIVE To assess the diagnostic accuracy of FTLD in an entire population, without restrictions related to patient age or diagnosing physician. METHODS Volumes of the "Annual of the Pathological Autopsy Cases in Japan," with reports of 130,105 autopsies throughout Japan from 2007 to 2016, were descriptively analyzed. RESULTS There were 219 patients with clinical and/or pathological diagnoses of FTLD. The sensitivity and specificity were 24.5% and 76.9%, respectively. Age at death for pathologically confirmed patients was 76.3 ± 11.6 years (mean ± standard deviation). Overlooked patients died significantly older than patients with an accurate clinical diagnosis. CONCLUSIONS Clinical diagnoses of FTLD had low sensitivity. Furthermore, the age at death of pathologically confirmed patients suggests that FTLD affects a wide age range and is not restricted to presenile individuals.
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Affiliation(s)
- Yoshihiko Horimoto
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan.
| | - Chikako Sato
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Ayuko Suzuki
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Aki Inagaki
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Toshihisa Tajima
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Hiroaki Hibino
- Department of Neurology, Nagoya City Rehabilitation Center, 1-2, Mikan-yama, Yatomi-cho, Mizuho, Nagoya, 467-8622, Japan
| | - Hiroshi Inagaki
- Department of Anatomic Pathology and Molecular Diagnostics, Nagoya City University, Mizuho, Nagoya, 467-8601, Japan
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