Basal ganglia: anatomy, pathology, and imaging characteristics

doi:10.1016/j.cpradiol.2003.09.004

Current Problems in Diagnostic Radiology

Volume 33, Issue 1, January–February 2004, Pages 28-41

https://doi.org/10.1016/j.cpradiol.2003.09.004 Get rights and content

Abstract

Several cases of bilateral basal ganglia lesions seen in magnetic resonance imaging initiated a review of the anatomy, pathology, and differential diagnoses of this region. There are a variety of disease entities that present as symmetrical basal ganglia abnormalities. Although these findings may not indicate a specific diagnosis, knowledge of the characteristics of diseases that affect this area can limit the differential considerations. Clinical information is often essential for narrowing the possible pathology that can be found here. The purpose of this article is to review the anatomy of the basal ganglia, the pathologies, clinical histories, and imaging characteristics that can cause bilateral basal ganglia lesions.

Section snippets

Anatomy

The anatomy and relationships of the basal ganglia can be confusing because of the variety of terms and definitions that describe this area, the complex interconnections, and the physiologic and chemical interactions. The components and method of naming the structures depends on whether one concentrates on the biochemical, embryological, or functional aspects of these complex structures. Numerous terms are used to describe the anatomy. In general, there are 4 major nuclei: (1) the corpus

Imaging

For the purposes of imaging, the structures of primary importance are: caudate, putamen, globus pallidus, and substantia nigra.

Calcification

Calcifications of the basal ganglia warrant special consideration because it is frequently seen and it is often perplexing as to when this finding needs to be further worked up. Brain CT scan, which easily detects calcium, is the preferred method to localize and assess the extent of cerebral calcifications. On MRI, calcified areas in the basal ganglia give a low-intensity signal on T2-weighted images and a low- or high-intensity signal on T1-weighted planes.

Any process that alters cerebral

Pathology

The basal ganglia are often involved in a bilateral fashion. Unilateral findings are often vascular insults. When bilateral abnormalities are encountered, the differential diagnoses in Table 1 should be considered.

References (24)

D.H. Geschwind et al.
Identification of a locus on chromosome 14q for idiopathic basal ganglia calcification (Fahr disease)
Am J Hum Genet
(1999)
A.K. Afifi et al.
Functional Neuroanatomy
(1998)
J.R. Jinkins
Atlas of Neuroradiologic Embryology, Anatomy, and Variants
(2000)
J.S. Citow et al.
Neuroanatomy and Neurophysiology: A Review
(2001)
M.R. DeLong
The basal ganglia
T.S. Gray
Functional and anatomical relationships among the amygdala, basal forebrain, ventral striatum, and cortexan integrative discussion
Ann NY Acad Sci
(1999)
A.G. Osborn
Diagnostic Cerebral Angiography
(1999)
C.R. Cohen et al.
Calcification of the basal ganglia as visualized by computed tomography
Radiology
(1980)
W.K. Lee et al.
The Kenny-Caffey syndromegrowth retardation and hypocalcemia in a young boy
Am J Med Genet
(1983)
A.L. Belman et al.
AIDScalcification of the basal ganglia in infants and children
Neurology
(1986)

T. Murata et al.

Conspicuity and evolution of lesions in Creutzfeldt-Jakob disease at diffusion-weighted imaging

AJNR

(2002)

K. Henkel et al.

Positron emission tomography with [(18)F]FDG in the diagnosis of Creutzfeldt-Jakob disease (CJD)

J Neurol

(2002)

Cited by (24)

Brain iron imaging markers in the presence of white matter hyperintensities
2023, Magnetic Resonance Imaging
To investigate the relationship between pathological brain iron deposition and white matter hyperintensities (WMHs) in cerebral small vessel disease (CSVD), via Monte Carlo simulations of magnetic susceptibility imaging and the development of a novel imaging marker called the Expected Iron Coefficient (EIC).
A synthetic pathological model of a different number of impenetrable spheres at random locations was employed to represent pathological iron deposition. The diffusion process was simulated with a Monte Carlo method with adjustable parameters to manipulate sphere size, distribution, and extracellular properties. Quantitative susceptibility mapping (QSM) was performed in a clinical dataset to study CSVD to derive and evaluate QSM, R2*, the iron microenvironment coefficient (IMC), and the EIC in the presence of WMHs.
The simulations show that QSM signals increase in the presence of increased tissue iron, confirming that the EIC increases with pathology. Clinical results demonstrate that while QSM, R2*, and the IMC do not show significant differences in brain iron, the EIC does in the context of CSVD.
The EIC is more sensitive to subtle changes in brain iron deposition caused by pathology, even when QSM, R2*, and the IMC fail.
MRI-Visible Anatomy of the Basal Ganglia and Thalamus
2022, Neuroimaging Clinics of North America
Citation Excerpt :
A third track called the pallidotegmental tract also projects from the GPi to the pedunculopontine nucleus in the midbrain to help regulate posture (we cannot see this tract on MR imaging). Altered basal ganglia function can result in movement disorders (Parkinson’s, Huntington, and Wilson diseases) or neuropsychiatric conditions (Tourette syndrome and obsessive–compulsive disorder).24,25 The ventral striatum, such as nucleus accumbens and adjacent structures (Fig. 3), form the complex reward circuit important to rational decision making and goal-directed behavior.26
Intracranial Arterial Calcification: Prevalence, Risk Factors, and Consequences: JACC Review Topic of the Week
2020, Journal of the American College of Cardiology
Citation Excerpt :
In the general population, calcifications are most often considered benign, although no published data on the association between basal ganglia vascular calcification and clinical outcomes in the general population were found. In younger persons, metabolic or developmental causes should be considered (Figure 5) (73). Intracranial arterial calcifications are a frequent finding on CT in the general population and can be found in all brain regions.
Intracranial large and small arterial calcifications are a common incidental finding on computed tomography imaging in the general population. Here we provide an overview of the published reports on prevalence of intracranial arterial calcifications on computed tomography imaging and histopathology in relation to risk factors and clinical outcomes. We performed a systematic search in Medline, with a search filter using synonyms for computed tomography scanning, (histo)pathology, different intracranial arterial beds, and calcification. We found that intracranial calcifications are a frequent finding in all arterial beds with the highest prevalence in the intracranial internal carotid artery. In general, prevalence increases with age. Longitudinal studies on calcification progression and intervention studies are warranted to investigate the possible causal role of calcification on clinical outcomes. This might open up new therapeutic directions in stroke and dementia prevention and the maintenance of the healthy brain.
Basal ganglia calcification
2020, Revue de Medecine Interne
Des calcifications des noyaux gris centraux sont fréquemment visibles sur les scanners cérébraux et particulièrement au niveau des globes pâles. Leurs fréquences augmentent de manière physiologique avec l’âge après 50 ans. Cependant des processus pathologiques peuvent aussi être associés à des dépôts de calcium au niveau des noyaux gris, de la fosse postérieure ou de la substance blanche. Des calcifications unilatérales orienteront le plus souvent vers une origine acquise. En revanche devant une atteinte bilatérale, une origine acquise mais aussi génétique sera recherchée après avoir éliminé une perturbation du métabolisme phosphocalcique. Dans ces contextes pathologiques, ces calcifications peuvent être accompagnées de symptômes neurologiques liés à la maladie sous-jacente : syndrome parkinsonien, troubles psychiatriques et cognitifs, épilepsie ou céphalées. L’objectif de cette mise au point est d’apporter une aide diagnostique, outre la clinique et la biologie, grâce à l’analyse de la topographie des calcifications et à l’étude des différentes séquences IRM.
Calcifications of the basal ganglia are frequently seen on the cerebral CT scans and particularly in the globus pallidus. Their frequency increases physiologically with age after 50 years old. However, pathological processes can also be associated with calcium deposits in the gray nuclei, posterior fossa or white matter. Unilateral calcification is often related to an acquired origin whereas bilateral ones are mostly linked to an acquired or genetic origin that will be sought after eliminating a perturbation of phosphocalcic metabolism. In pathological contexts, these calcifications may be accompanied by neurological symptoms related to the underlying disease: Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy or headache. The purpose of this article is to provide a diagnostic aid, in addition to clinical and biology, through the analysis of calcification topography and the study of different MRI sequences.
Lenticulostriate arterial distribution pathology may underlie pediatric anoxic brain injury in drowning
2016, NeuroImage: Clinical
Citation Excerpt :
The basal ganglia nuclei comprise the extrapyramidal system and play an integral role in the production and control of voluntary movement. With reciprocal projections with the cerebral cortex and thalamus, these nuclei receive, modify, and relay motor information; lesions can thus result in substantial motor-system impairments (Anderson et al., 2004; Hegde et al., 2011). In the deep white matter adjacent to the basal ganglia, the PLIC contains corticospinal fibers that relay motor information from the primary motor cortex to lower motor neurons.
Drowning is a leading cause of neurological morbidity and mortality in young children. Anoxic brain injury (ABI) can result from nonfatal drowning and typically entails substantial neurological impairment. The neuropathology of drowning-induced pediatric ABI is not well established. Specifically, quantitative characterization of the spatial extent and tissue distribution of anoxic damage in pediatric nonfatal drowning has not previously been reported but could clarify the underlying pathophysiological processes and inform clinical management. To this end, we used voxel-based morphometric (VBM) analyses to quantify the extent and spatial distribution of consistent, between-subject alterations in gray and white matter volume. Whole-brain, high-resolution T1-weighted MRI datasets were acquired in 11 children with chronic ABI and 11 age- and gender-matched neurotypical controls (4–12 years). Group-wise VBM analyses demonstrated predominantly central subcortical pathology in the ABI group in both gray matter (bilateral basal ganglia nuclei) and white matter (bilateral external and posterior internal capsules) (P < 0.001); minimal damage was found outside of these deep subcortical regions. These highly spatially convergent gray and white matter findings reflect the vascular distribution of perforating lenticulostriate arteries, an end-arterial watershed zone, and suggest that vascular distribution may be a more important determinant of tissue loss than oxygen metabolic rate in pediatric ABI. Further, these results inform future directions for diagnostic and therapeutic modalities.
Basal ganglia lesions in children and adults
2013, European Journal of Radiology
Citation Excerpt :
The findings are not specific in most cases and must be considered in the context of clinical status and other tests but knowledge of the diseases that affect basal ganglia can limit the spectrum of differential diagnoses. There are a few papers in the literature reviewing basal ganglia lesions [1–4]. The authors present a more detailed review with rich iconography from the own archive.
The term “basal ganglia” refers to caudate and lentiform nuclei, the latter composed of putamen and globus pallidus, substantia nigra and subthalamic nuclei and these deep gray matter structures belong to the extrapyramidal system. Many diseases may present as basal ganglia abnormalities. Magnetic resonance imaging (MRI) and computed tomography (CT) – to a lesser degree – allow for detection of basal ganglia injury. In many cases, MRI alone does not usually allow to establish diagnosis but together with the knowledge of age and circumstances of onset and clinical course of the disease is a powerful tool of differential diagnosis. The lesions may be unilateral: in Rassmussen encephalitis, diabetes with hemichorea/hemiballism and infarction or – more frequently – bilateral in many pathologic conditions. Restricted diffusion is attributable to infarction, acute hypoxic–ischemic injury, hypoglycemia, Leigh disease, encephalitis and CJD. Contrast enhancement may be seen in cases of infarction and encephalitis. T1-hyperintensity of the lesions is uncommon and may be observed unilaterally in case of hemichorea/hemiballism and bilaterally in acute asphyxia in term newborns, in hypoglycemia, NF1, Fahr disease and manganese intoxication. Decreased signal intensity on GRE/T2*-weighted images and/or SWI indicating iron, calcium or hemosiderin depositions is observed in panthotenate kinase-associated neurodegeneration, Parkinson variant of multiple system atrophy, Fahr disease (and other calcifications) as well as with the advancing age. There are a few papers in the literature reviewing basal ganglia lesions. The authors present a more detailed review with rich iconography from the own archive.

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View full text

Basal ganglia: anatomy, pathology, and imaging characteristics

Abstract

Section snippets

Anatomy

Imaging

Calcification

Pathology

Am J Hum Genet

Functional Neuroanatomy

Atlas of Neuroradiologic Embryology, Anatomy, and Variants

Neuroanatomy and Neurophysiology: A Review

The basal ganglia

Functional and anatomical relationships among the amygdala, basal forebrain, ventral striatum, and cortexan integrative discussion

Ann NY Acad Sci

Diagnostic Cerebral Angiography

Calcification of the basal ganglia as visualized by computed tomography

Radiology

The Kenny-Caffey syndromegrowth retardation and hypocalcemia in a young boy

Am J Med Genet

AIDScalcification of the basal ganglia in infants and children

Neurology

Conspicuity and evolution of lesions in Creutzfeldt-Jakob disease at diffusion-weighted imaging

AJNR

Positron emission tomography with [(18)F]FDG in the diagnosis of Creutzfeldt-Jakob disease (CJD)

J Neurol