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Brain imaging in MSA revealed that distinct cerebellar and medullary atrophy patterns were closely linked to cardiovascular autonomic dysfunction.  

A study published in June 2025 issue of European Journal of Neurology reported that early severe autonomic failure (AF) in multiple system atrophy (MSA) was linked to poor survival and associated with degeneration of preganglionic autonomic neurons in the brainstem and spinal cord.  

Researchers conducted a retrospective study to characterize cerebral changes in brain imaging associated with cardiovascular AF.  

They evaluated cardiovascular sympathetic failure using orthostatic hypotension (OH) based on systolic and diastolic blood pressure changes during tilt testing (ΔSBP and ΔDBP). Cardio-vagal dysfunction was assessed using a composite score derived from the root-mean-square differences of successive R-R intervals (RMSSD) and heart rate (HR) changes during deep breathing, T1-weighted anatomical images were analyzed using voxel-based morphometry SPM12, volumetric analysis, and cortical thickness measurements (FreeSurfer 7.0) to detect gray matter (GM) atrophy in sub-tentorial brain regions. Multivariate analysis was adjusted for age, disease severity measured UMSARS, and total intracranial volume.  

The results showed that 62 individuals with MSA from the French Reference Center were analyzed, with a mean age of 67.3 ± 8.6 years, 69.4% diagnosed with parkinsonian subtype (MSA-P), and an average disease duration of 4.2 ± 2.1 years. Medullary atrophy significantly correlated with OH (P< 0.006). Reduced GM volume in the left anterior cerebellum (lobule V) was associated with changes in ΔDBP (pFWEc = 0.017). The GM atrophy in the left interposed nucleus correlated with changes in ΔSBP (P < 0.003), while reduced volume in the right dentate nucleus was linked to lower heart rate variability (P< 0.003).  

Investigators concluded that medullary atrophy was strongly linked to OH and cerebellar degeneration correlated with the severity of cardiovascular AF. 

Source: onlinelibrary.wiley.com/doi/10.1111/ene.70212