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An Autopsy Case of Idiopathic Parkinsonism with Numerous Lewy Bodies in the Cerebral Cortex : Diffuse Lewy Body Disease Toshio Akashi 1 , Nobuyuki Maruyama 2 , Hiroyuki Sawayama 2 1National Center Hospital for Mental, Nervous, and Muscular Disorders, National Center of Neurology and Psychiatry 2National Tokachi Sanatorium Keyword: parkinsonism , Lewy body(LB) , pallidum , Luy's body , diffuse Lewy body disease pp.175-181
Published Date 1991/2/1
DOI https://doi.org/10.11477/mf.1406900163
  • Abstract
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We report an autopsy case of a 73 year-old female with idiopathic parkinsonism, characterized path-ologically by the wide spread appearance of Lewy bodies (LBs) not only in the pigmented neurons in the midbrain and brainstem but also in the cerebral cortex. Initial symptoms at the age of 62 were finger tremor and gait disturbance, which were followed mainly by mental deterioration, such as regression, dependency, auditory hallucination, depression, emotional incontinence, and a personality change. In the terminal stage, nuchal stiffness in extension, one of the hallmarks of progressive supranuclear palsy, and slow and generalized tremor in all 4 extremities were noted. She died of aspiration pneu-monia.

The brain was somewhat small and weighed 1100 g after the fixation by formalin. Macroscopical findings included mild cerebral atrophy with mild pial thickening both in the frontal and temporal lobes and slight expansion of the ventricular system. Histopathologically, severe loss of neuronal cells in both the pallidum and Luy's body and moderate loss of large cells in the putamen were noted in addition to the typical findings of Parkinson's disease in the substantia nigra and locus caeruleus including neur-onal cell loss, depigmentation, and gliosis. These findings in the basal ganglia were more conspicuous than the two controls of classical Parkinson's disea-se. The distribution, stainability in the routine methods of staining, and shape of Lewy bodies in the cerebral cortex conformed to those of previous reports. The similar case reports in the literatures do not seem to have paid much attention to the findings of the basal ganglia observed in our case. With regard to the senile changes, neurofibrillary tangles in the cerebral cortex appeared only in the Ammon's horn and the parahippocampal gyrus, but senile plaques were not detected throughout the brain. These senile changes were thought to bewithin normal limits for the age of the patient.

Although there are not a few studies on the role of the globus pallidus in parkinsonism, the main target of interest in the fields of neuropathology, neuro-chemistry, and allied studies are focused, at present, on the nigro-striatal dopaminergic system. How-ever, for further understanding of parkinsonism inthe neuropathological studies, more precise investi-gations on the basal ganglia regions other than the commonly affected areas, i. e., substantia nigra and locus ceruleus, appear to be essential in parkin-sonism.


Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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