Stridor-related gray matter alterations in multiple system atrophy: A pilot study

Parkinsonism Relat Disord. 2019 May:62:226-230. doi: 10.1016/j.parkreldis.2018.11.018. Epub 2018 Nov 17.


Introduction: The neuroanatomical substrate of stridor associated with Multiple System Atrophy (MSA) remains unclear. We evaluated stridor-related gray matter (GM) changes in MSA.

Methods: 36 MSA patients underwent standardized nocturnal video-polysomnography and brain MRI. Differences in GM density between MSA patients with and without stridor and a sample of 22 matched healthy controls were evaluated with Voxel Based Morphometry protocol supplemented by a specific tool (SUIT) for analysing infratentorial structures.

Results: Stridor was confirmed in 14 patients (10 MSA-cerebellar variant; 10 M; mean ± SD age = 61.6 ± 8.9years; disease duration = 5.2 ± 2.9years) and absent in 22 (11 MSA-cerebellar variant; 18 M; age = 61.4 ± 9.9years; disease duration = 4.8 ± 3.4years). Compared to MSA without stridor, patients with stridor showed higher GM density in the cerebellum (p < 0.05, corrected for the MSA-cerebellar variant and uncorrected when considering both MSA-variants) and lower in the striatum (p < 0.05, uncorrected).

Conclusions: This preliminary study has demonstrated for the first time in MSA stridor-related GM changes in striatal and cerebellar regions. Abnormalities in these regions were previously reported in dystonic disorders affecting laryngeal muscles, suggesting the hypothesis that stridor pathophysiology is dystonia-related. These results need however to be confirmed in a larger sample of patients.

Keywords: Multiple system atrophy; Stridor; Voxel based morphometry.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging*
  • Brain / physiology
  • Female
  • Gray Matter / diagnostic imaging*
  • Gray Matter / physiology
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Multiple System Atrophy / diagnostic imaging*
  • Multiple System Atrophy / physiopathology
  • Pilot Projects
  • Polysomnography / methods
  • Respiratory Sounds* / physiology
  • Retrospective Studies