Basal ganglia: anatomy, pathology, and imaging characteristics

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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.

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