Christie M. Lincoln, MD, Jacqueline A. Bello, MD, and Yvonne W. Lui, MD

Neurographics 2:92102 Sep 2012 www.neurographics.com

Presented by : dr. DILA SITI HAMIDAH

Lecturer : dr. H.FARHAN ANWARY, Sp.Rad(K), MH.Kes

INTRODUCTIONBASAL GANGLIA

collection of deep gray matter nuclei

play a major role in the extrapyramidal system

contribute to:

higher emotional

sensorimotor

associative

cognitive

INTRODUCTION

Imaging Anatomy

Neuronal Circuitry

Imaging Appearance of PathologicProcesses

ANATOMYPaired structures

One set of nuclei within each cerebral hemisphere

and hemi-brain stem

CAUDATE NUCLEUS

LENTIFORM NUCLEUS

PUTAMEN GLOBUS PALLIDUS

SUBTHALAMIC NUCLEUS

SUBSTANTIA NIGRA

Axial T1-weighted MR image demonstrates the

putamen (short arrow) and globus

pallidus (arrow), collectively referred to as

the lentiform

nucleus. An asterisk is over the caudate

head

Caudate Nucleus TAILED

Derived from the telencephalon

Composed of : HEAD, BODY, TAIL

Follows the lateral wall of the lateral ventricle with its tail terminating at the amygdala

Caudate Nucleus Bilateral or unilateral lesions of the caudate :

Abulia

Apathetic affect with loss of:

initiative

spontaneous thought

emotional response

Lentiform Nucleus Comprises

2 parts :

Putamen

Globuspallidus

lenslike shaped

The globus palliduscomprises 2 segmentsthat is, internal (black arrow) and external (white arrow) segmentsseparated by the internal medullarylamina

Globus Pallidus

Subthalamic Nucleus

Substantia Nigra

Vascular Supply Rich vascular supply

Primary constributor : the medial and lateral lenticulostriate arteries, and the recurrent artery of Heubner

The medial lenticulostriates

The medial basal ganglia, caudate nucleus, and internal capsule

Arise from the A1 segment of the ACA

Vascular Supply The recurrent artery of Heubner

The superolateral caudate head, the anterior limb of the internal capsule, and the anterior lentiform nucleus

The largest and longest of the perforating branches, typically arises from the proximal A2 segment of the ACA

The lateral lenticulostriates

The lateral putamen, caudate nucleus, and external capsule

Arise from the M1 segment of the MCA

Vascular Supply The substantia nigra is supplied by:

Its caudal extent : peduncular branches of the posterior cerebral artery, the medial posterior choroidal artery, and the superior cerebellar artery.

Its rostral region : the premamillary branches of theposterior communicating artery and the peduncular branches of the anterior choroidalartery

Vascular Supply The subthalamic region is supplied by :

Posteromedial arteries derived from the posterior communicating and posterior cerebral artery

The peduncular branches of the anterior choroidalartery

Neuronal Circuitry Several different neurotransmitters :

GABA

Dopamine

Acetylcholine

Glutamine

Enable the function of the basal ganglia as an intermediary between the cortex and the thalamus viathe basal gangliathalamocortical circuits

Neuronal Circuitry Consist of 2 circuits :

Direct

Indirect

Maintain somatotopic organization of movement forfluidity and coordination

IMAGING Most of the basal ganglia are well-demonstrated on

crosssectional imaging

Noncontrast CT shows the caudate, putamen, and globus pallidus relatively high attenuationcompared with white matter

On MR imaging, the caudate and putamen generallyfollow cortical gray matter signal intensity

IMAGING In the healthy adult :

The globus pallidus, subthalamic nucleus, and substantia nigra : relatively hypointense to cortical gray matter on T2WI, due to higher iron concentration

In a young patient:

The substantia nigra is hyperintense on T2WI

IMAGING Imaging is useful in the evaluation of basal ganglia

abnormalities

CT is the most commonly performed brain imagingand demonstrates calcification, acute hemorrhage, prior ischemic injury, and volume loss

MR imaging is advantageous in delineating anatomy and demonstrating signal-intensity alteration

IMAGING ALGORITHM: CTHYPERDENSE

HEMORRHAGE

CONTRAST POST

ANGIOGRAM

CALSIFICATION AGE RELATED

METABOLISM ABNORMALITY

FAHR DISEASE

HIV

DOWN SYNDROME

A 70-year-old woman with a history of hypertension presentswith headache. Noncontrast head CT shows acute

hemorrhage in the leftlentiform nucleus

A 53-year-old man immediately after a conventional cerebral angiography has a noncontrast head CT, demonstrating left lentiform

hyperattenuation, which resolved on follow-up imaging the next day (not shown).

Fig 5. A, A 45-year-old woman with Fahr disease manifesting hyperattenuation/calcification of the bilateral lentiform nuclei on noncontrasthead CT. B, A 16-year-old HIV-positive girl also with hyperattenuation/calcification of the bilateral lentiform nuclei on noncontrast head CT. C, A21-year-old man with Down syndrome (trisomy 21) has noncontrast headCT demonstrating bilateral lentiform calcifications.

IMAGING ALGORITHM: CT

HYPODENSE

EDEMA

INFARK

OLD HEMORRHAGE

A 29-year-old man with hypoxic brain injury after heroin overdosehas hypoattenuation within the lentiform nucleus and caudate on

noncontrast CT

A 58-year-old man with left hemineglect has noncontrast

head CT using a narrow window showing subtle

hypoattenuation in the right lentiform nucleus

(A). Gray scale cerebral blood volume perfusion map (B). clearly shows the

perfusion deficit

Noncontrast head CT in a 68-year-old woman with known Huntington disease shows atrophy of the bilateral caudate nuclei resulting in a boxlike configuration to the frontal horns.

IMAGING ALGORITHM : MRI

T1 HYPERINTENSE

HYPOXIA

HYPERALIMENTATION WILSON DISEASE

CHRONIC LIVER FAILURE

A T1-weighted MR image in a 56-year-old man with hepatoma and hepatic

encephalopathy shows hyperintensitywithin the bilateral globus pallidi

IMAGING ALGORITHM: MRI

PUTAMEN

LEIGH DISEASE

METHANOL TOXICITY

PRION DISEASE

WILSON DISEASE

GLOBUS PALLIDUS

HYPOXIA

HYPOGLICEMIA

HALLERVODEN-SPATZ

DISEASE

CO TOXICITY

NF 1

T2 HYPERINTENSE

HIE in a 38-year-old woman who was resuscitated after being involved in a traffic accident. (a) T2-weighted MR image demonstrates

bilaterally symmetric hyperintense areas in the thalamus (white arrowheads), basal ganglia, and cerebral cortex. Black arrowheads =

caudate nuclei, arrows = lentiform nuclei

CO poisoning Symmetric CT

hypoattenuationand T2 hyperintensity due to necrosis in the globus pallidus are characteristic of carbon monoxidepoisoning Noncontrast head CT in a 30-year-old man with

carbon monoxide poisoning shows characteristicbilateral globus pallidal necrosis

Neurofibromatosis type I An autosomal dominant

disorder and one of the most common phakomatoses

T2 prolongation typically affects the globus pallidus and the brain stem, cerebellum, and thalamus

An 18-year-old woman with neurofibromatosis 1 also demonstrating

characteristic irregular hyperintense signal intensity on T2WI in the bilateral globus

pallidi.

Hallervoden-Spatz (PKAN) MR imaging:An eye of the tiger

appearance, withbilateral central T2 hyperintensityrepresenting gliosis

Surrounded by a rim of T2 hypointensity, representing iron inthe globus palliduson T2-weighted sequences

Leigh Disease Progressive hereditary neurodegenerative disorder

Involves brain structures highly dependent on glucose metabolism (ie, the lentiform nuclei and caudatenuclei)

Additional areas including the thalamus, periaqueductal gray, tegmentum, red nuclei, anddentate nuclei

Symmetric T2 signa-intensity abnormality

Toxic and Metabolic Insults The toxin that produces bilateral putaminal lesions is

methanol poisoning

Patients often present with metabolic acidosis

Classic MR imaging findings of bilateral putaminalnecrosis, which may be associated with hemorrhage

31-year-old woman with known history of Wilson disease presents with characteristic MR imaging findings of lateral putaminal T2 hyperintensity (arrow)

A 40-year-old woman with progressive multifocal neurologic dysfunction who underwentMR imaging with symmetric T2 signal intensity abnormality in the bilateral caudate heads,bilateral putamina, and bilateral subinsular ribbon and bifrontal cortex, which are imagingfindings shared by all types of prion diseases (A). Diffusion-weighted imaging showsrestricted diffusion in the same areas (B).

Perivascular Space Dilatation Perivascular spaces or Virchow-Robin spaces

containing perforating lenticulostriate arteries course through the inferior basal ganglia

Generalized cerebral volume loss, metabolic disorders,and central nervous system infection perivascularspaces enlargement

An MR image of an 87-year-old woman with memory loss who shows prominent perivascular spaces following the CSF on all pulse sequences including T2

Substantia Nigra and SubthalamicNucleus Nigrostriatal denervation, the hallmark of Parkinson

disease, leads to overactivity of the globus pallidusinterna and the substantia nigra pars reticulata.

The cardinal motor signs found in Parkinson disease, akinesia, rigidity, and resting tremor, are attributed to loss of dopaminergic input to the striatum, which results from degeneration of the substantia nigra pars compacta

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