Morning glory sign (midbrain)

Last revised by Daniel J Bell on 17 Oct 2019

Morning glory sign of progressive supranuclear palsy (PSP) and multisystem atrophy, not to be confused with morning glory syndrome, refers to the appearance of the midbrain on axial imaging 1.

Graphically this is identified on an axial image at the level of the midbrain by drawing 1:  

  • a horizontal line drawn through the edge of the posterior cerebral aqueduct
  • a second line is drawn along the lateral margin of the tegmentum from the intersection of the horizontal line to the "pit" between the tegmentum and the cerebral peduncle

In normal subjects the lateral margin of the tegmentum is convex and runs outside of this second line. However, in patients with progressive supranuclear palsy and multisystem atrophy with vertical supranuclear gaze-palsy the tegmentum is concave and the lateral margin runs inside the second line. 

The morphology of the midbrain in patients with vertical supranuclear gaze-palsy resembles the morning glory flower thus termed the morning glory sign as originally described by Adachi et al 1

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Cases and figures

  • Figure 1: morning glory flower
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  • Case 1
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