Clinical Autonomic Research

, Volume 22, Issue 1, pp 57–61 | Cite as

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

  • David S. Goldstein
  • Courtney Holmes
  • LaToya Sewell
  • Mee Yeong Park
  • Yehonatan Sharabi
Case Report

Abstract

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.

Keywords

Parkinson Synuclein Braak Sympathetic nervous system Norepinephrine 

Abbreviations

18F-DA

6-[18F]Fluorodopamine

PUT:OCC

Putamen:occipital cortex

Notes

Acknowledgments

This research was supported by the Intramural Research Program of the NIH, National Institute of Neurological Disorders and Stroke. Ms. Tereza Jenkins (Clinical Neurocardiology Section) coordinated patient travel. Sandra Pechnik, RN (Clinical Neurocardiology Section) assisted with clinical procedures and scheduling.

Conflict of interest

None.

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Copyright information

© Springer-Verlag (outside the USA) 2011

Authors and Affiliations

  • David S. Goldstein
    • 1
  • Courtney Holmes
    • 1
  • LaToya Sewell
    • 1
  • Mee Yeong Park
    • 1
  • Yehonatan Sharabi
    • 1
  1. 1.Clinical Neurocardiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaUSA

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