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Microscopic neuropathology of progressive supranuclear palsy (PSP)

Microscopic neuropathology of progressive supranuclear palsy (PSP)
The patient was diagnosed clinicaly with PSP-parkinsonism, a variant of classic PSP. The substantia nigra (A-E) shows neuronal loss and gliosis. Several surviving neurons contain globose neurofibrillary tangles (NFTs) (A, arrows). Tau immunostaining (B) demonstrates the NFTs (arrows) and numerous thread-like processes. The globose NFT expands the cytoplasmic profile of residual neurons (A-C) and its characteristic coiled "ball of yarn configuration" is highlighted by routine silver preparations (D) and tau (E). Tau-immunoreactive neuroglial lesions are widespread and include NFTs (arrows), pretangles (arrowhead), tufted astrocytes (thin arrows), and threads in neocortex (F) and striatum (G). Selective anti-4R tau decorates a tufted astrocyte in the subthalamic nucleus (H) and an oligodendroglial coiled body (I) in the internal capsule, as well as numerous thread-like deposits.
A, C: hematoxylin-eosin; B, E-G: anti-tau; D: Bielschowsky; H, I: anti-4R tau; A, B: original magnification x200; C-E, H, I: original magnification x600; F, G: original magnification x400.
Reproduced with permission from: Golbe LI, Boeve BF, Keegan BM, Parisi JE. An 81-year-old man with imbalance and memory impairment. Neurology 2007; 68:1147. Copyright © 2007 Lippincott Williams & Wilkins.
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