{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T18:40:50Z","timestamp":1772476850537,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,11,7]],"date-time":"2021-11-07T00:00:00Z","timestamp":1636243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Clinical diagnosis of atypical parkinsonisms may be challenging. The eye\u2010of\u2010the\u2010tiger sign on brain MRI, typical of neurodegeneration with brain iron accumulation, has been anecdotally observed in cases clinically diagnosed as atypical parkinsonisms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To show how clinical syndromes and even neuroimaging sometimes may lead the neurologist to a misunderstanding, just as to emphasize the important role of pathology to establish the final diagnosis in these cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinico\u2010pathological case.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A 67\u2010year\u2010old\u2010woman presented with progressive painful stiffness and allodynia in her left arm. On examination, she presented parkinsonism without tremor with greater involvement of left limbs. She developed dystonia, with myoclonic tremor and hypoesthesia involving her left arm, as well as an impairment of balance with falls, a significant axial involvement with disabling rigidity, supranuclear gaze abnormalities, facial dystonia, dysphonia, severe dysphagia, and anarthria. There was no response to levodopa. Syndromic diagnosis and findings on neuroimaging are discussed. Afterwards, the underlying pathology is revealed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We present the first case of neuropathologically confirmed multiple system atrophy with the eye\u2010of\u2010the\u2010tiger sign on brain MRI. The presence of supranuclear vertical gaze palsy further complicated a correct clinical diagnosis. A pathological postmortem study remains essential to establish a definite diagnosis in atypical parkinsonisms.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.13366","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T08:27:18Z","timestamp":1635236838000},"page":"98-103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Eye\u2010of\u2010the\u2010Tiger Sign with an Unexpected Pathological Diagnosis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5771-5005","authenticated-orcid":false,"given":"Elena","family":"Natera\u2010Villalba","sequence":"first","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7744-6850","authenticated-orcid":false,"given":"Juan Carlos","family":"Mart\u00ednez\u2010Castrillo","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal  Madrid Spain"},{"name":"IRYCIS (Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria). Hospital Universitario Ram\u00f3n y Cajal  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Luis","family":"L\u00f3pez\u2010Send\u00f3n Moreno","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal  Madrid Spain"},{"name":"IRYCIS (Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria). 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