REM-sleep-behavior-disorder (RBD) is characterized by the absence of muscle-atonia during REM-sleep and is thought to be related to a dysfunction of brainstem-nuclei (Bn) of the arousal/motor networks. Yet, a precise identification of the Bn involved in vivo is still missing, thus limiting our understanding of this disease. Through multi-contrast high-spatial-resolution 7Tesla-MRI and a recently developed stereotaxic-Bn-atlas, we consistently detected across RBD-patients microstructural-changes in a subregion of the substantia nigra, consistent with pars reticulata, and in a peri-nigral area. Interestingly, these changes were compatible with the presence of lacunar infarcts, finding that differs from recent reports of nigral iron-accumulation in RBD.
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