[Infantile neuroaxomal dystrophy or Seitelberger's disease. Clinical, histological and ultrastructural study of 2 observations]

Neuroaxonal dystrophy in infantile alpha-N-acetylgalactosaminidase deficiency

Morphologic alterations in biopsies of central and peripheral nervous tissue were investigated at the light-and electron-microscopic level in the first cases of lysosomal alpha-N-acetylgalactosaminidase deficiency. Widespread spheroid formation was observed in terminal and preterminal axons. Neocortical and peripheral autonomic axons contained tubulovesicular and lamelliform membranous arrays, prominent acicular clefts, and electron-dense axoplasmic matrix, the typical ultrastructural abnormalities corresponding to axonal spheroids in many inherited and acquired axonopathies. Central and peripheral membranous distal axonal spheroids were the only neuropathologic abnormality identified; other alterations resembling those in various neuronopathic lysosomal storage diseases were not observed. The morphologic findings and the distribution of the lesion in the present disorder are remarkably similar to those reported in the inherited infantile form of neuroaxonal dystrophy with normal alpha-N-acetylgalactosaminidase activity (Seitelberger disease).

Neuronal inclusions of Parkinson's disease

Two distinct neuronal inclusions occur in Parkinson's disease. The Lewy body is the diagnostic hallmark and is recognized by its eosinophilic body and unstained halo. It can be found in specific regions of the nervous system, where its frequency, size, shape, and structure differ. Large neurons of the dorsal vagal nucleus and sympathetic ganglia often contain particularly large quantities of Lewy-body-like matter. It consists of filament in the outer part and electron dense material in the core, the outer part staining with silver and with antibodies to neurofilament and tubulin. The pale body is restricted to the substantia nigra and locus ceruleus. It does not react with conventional stains, silver, or neurofilament antibodies, and has a homogeneous structure with a granular and vesicular surface texture. It contains sparse granular matter, vacuoles, and filaments, surrounded by melanin. The Lewy body and pale body may be juxtaposed or contiguous in some cells, but their distinct appearances and structures indicate that they are separate inclusions.

Diagnosis of juvenile-adult form of neuroaxonal dystrophy by electron microscopy of rectum and skin biopsy

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Neuronal lipidosis and neuroaxonal dystrophy in cerebro-hepato-renal (Zellweger) syndrome

Neuropathological examination of three males with cerebro-hepato-renal (Zellweger) syndrome (CHRS) revealed selective neuronal lipidosis and neuroaxonal dystrophy of the dorsal nucleus of Clarke and lateral cuneate nucleus. This lipidotic alteration was visualized as perikaryal or axonal enlargements with cytoplasmic striations. With the light microscope, the striated material was birefringent and resistant to traditional lipid stains; ultrastructurally, it was composed of lipid clefts, lamellae and lamellar-lipid profiles; biochemically, the affected region contained large amounts of cholesterol esterified to very long-chain fatty acids, both saturated and monounsaturated. This metabolic lesion, though localized to specific sensory neurons, suggests that a more generalized defect in neuronal fatty acid metabolism may be operative in CHRS.

Cerebral gangliocytoma. An ultrastructural study

We report a case of cerebral gangliocytoma (GC) with a variety of unusual structures in the tumor cells. Light microscopically, the tumor consisted of typical ganglion cells, atypical cells which has argyrophilic granules in the cytoplasm, and a few astrocytes. Electron microscopically, the tumor cells showed typical gangliocytic features, which had abundant rough endoplasmic reticula, ribosomes and cored vesicles of 90-150 nm diameter, a few 50-nm-diametered non-cored vesicles, and other common organelles in their cytoplasm. Furthermore, neoplastic ganglion cells contained a variety of abnormal structures, including membranous cytoplasmic bodies (MCB), Zebra bodies (ZB), tubular structures, branched tubular structures (BTS), concentrical laminated bodies and curvilinear bodies (CB). The MCB, ZB and CB resembled those in GM2 gangliosidosis (GMG), and the BTS that in infantile neuroaxonal dystrophy (INAD). Although the significance of these inclusions is still unknown, it is considered that some common mechanism might play a role in the metabolism of both neoplastic neuronal cells and degenerating neurons (GMG and INAD). Synapses could not be observed anywhere despite complete neuronal differentiation of many tumor cells.

Pathology of skeletal muscle and intramuscular nerves in infantile neuroaxonal dystrophy

Biopsies of the biceps muscle and sural nerve were taken from a girl aged 2 years with infantile neuroaxonal dystrophy (INAD). In addition to the typical axonal spheroid bodies in a number of the i.m. nerve fibers, the neuromuscular junctions (NMJs) and motor nerve endings also contained axonal swellings. The sural nerve, except for three dystrophic fibers, was almost completely normal. A teased nerve preparation showed four additional abnormal fibers with focal axonal enlargement similar to those in giant axonal neuropathy (GAN). These results suggest that a biceps muscle biopsy may be more useful than a sural nerve biopsy for the diagnosis of INAD, because the muscle contains abnormal peripheral nerves and NMJs in high frequency.

Histological and ultrastructural features of dystrophic isocortical axons in infantile neuroaxonal dystrophy (Seitelberger's disease)

The histological and ultrastructural features of axonal swellings are described in a cerebral biopsy specimen from a 6-year-old girl with infantile neuroaxonal dystrophy. In agreement with previous reports, several swellings were identified as axonal terminals, and it is postulated that the prevailing axonal swellings in cerebral cortex represent dystrophic boutons. Microscopically, dystrophic cortical boutons are morphologically different from typical subcortical spheroids and can be easily identified in routine histological preparations. Five ultrastructural elements were present in most axonal swellings: clusters of characteristic membranous bodies, stacks of elongated membranes, mitochondria, groups of vesicles, and an amorphous matrix. In spite of widespread axonal enlargement, the cerebral cortex was not thickened, and, in fact, the gyri looked atrophic in computerized axial tomograms. These findings suggest that some normal cortical element must be deficient, but such a structure remains to be identified.

Diminished retrograde transport causes axonal dystrophy in the nucleus gracilis. Electron- and light-microscopic study

To examine a possible cause of axonal dystrophy in the nucleus gracilis, dorsal root ganglion (DRG) neurons of rats were investigated by means of electron-microscopic autoradiography and horseradish peroxidase (HRP) tracing method. Following injections of tritiated amino acids into the L6 and S1 DRG, labeling was observed on the initial and halfway developed dystrophic terminals in the ipsilateral gracile nucleus. However, no grains or few, if any, were found on the well developed huge dystrophic endings. Compared with the thoracic and upper lumbar DRG, a decrease in velocity and amount of retrograde HRP transport was demonstrated in the lower lumbar and sacrococcygeal DRG neurons, especially of large cell diameter, irrespective of age of rats. These findings led us to conclude that the axonal dystrophy reflects a state of an anterograde overtransport of the axoplasm caused by a diminished retrograde transport which is specific to lower lumbar and sacrococcygeal DRG large neurons.

Neuroaxonal dystrophy with neuromelanin deposition, neurofibrillary tangles, and neuronal loss. Light- and electron-microscopic changes in a 45-year-old woman with progressive psychomotor deterioration

Neuroaxonal spheroids became evident microscopically after the autopsy of a 45-year-old woman with pigmentation of the globus pallidus suggesting Hallervorden-Spatz disease. In our opinion the fine floccular pigment seen electron-microscopically in many of the axonal spheroids is melanin, an end product of catecholamine metabolism. Neurofibrillary degeneration, senile plaques, and granulovacuolar degeneration in the hippocampus produced a picture of Alzheimer's disease. Pontocerebellar degeneration and motor neuron disease were also observed.

Neurobiological studies of experimental diphenylhydantoin intoxication--III. Electron microscopic studies on development and disintegration mechanism of altered axon terminals and synaptic endings in rat cerebellum with chronic diphenylhydantoin intoxication

The processes of development and disintegration of axonal spheroids were electron microscopically studied in the rat cerebellum with chronic diphenylhydantoin intoxication. According to the severity and character of membrane accumulation, the whole course ranging from development to disintegration of altered axon terminals and synaptic endings in the DPH-intoxicated rat cerebellum was classified into the following four stages--initial, moderate, advanced and terminal. The initial stage was characterized by the appearance of a small number of interconnected tubules 150 to 350 A in diameter in non-enlarged axon terminals and synaptic endings. Usually these tubular structures tended to congregate in a certain part of axoplasm so that there were no intimate relationships between them and ordinary cell organelles. The moderate stage was characterized by an increased number of interconnected tubules in slightly or moderately swollen axon terminals and synaptic endings. The advanced stage was characterized by an extraordinary number of interconnected tubules in extremely highly swollen axon terminals and synaptic endings. Membranous scrolls and/or membranous strands separated by a cleft-like space were also found in an association with interconnected tubules so that the morphological organization of spheroids in the rat cerebellum with chronic DPH intoxication was very analogous to those of infantile neuroaxonal dystrophy. The terminal stage was characterized by the following three axonal events, i.e., rarefaction and coagulation necroses, and phagocytosis of spheroids by glial elements, presumably astrocytic in origin. The formation and fate of such axonal spheroids have not as yet been shown and discussed by electron microscopists. Thus the present paper was the first to reveal the electron microscopic observations suggestive of the details of development and disintegration mechanisms of spheroids by means of animal experimentations.

'Acrylamide-induced' neuropathy and impairment of axonal transport of proteins. II. Abnormal accumulations of smooth endoplasmic reticulum as sites of focal retention of fast transported proteins. Electron microscope radioautographic study

The distribution of fast axonally transported proteins was studied by electron microscope radioautography in ciliary ganglia of chickens treated or not treated with acrylamide. At 3 h after the intracerebral injection of [3H]lysine, the preganglionic axons of the untreated chickens displayed few silver grains, mainly associated with smooth endoplasmic reticulum (SER) profiles. In most axons of acrylamide-treated chickens, a similar pattern was observed, except in axons which exhibited focal and intense labeling underneath the axolemma: clusters of silver grains indeed overlayed peripheral accumulations of tubulovesicular profiles of SER, dense core vesicles and mitochondria. After impregnation with heavy metals, electron microscope observation of 1 micrometer thick sections showed a locally disorganized SER forming a complex network of tubules intermingled with vesicles and mitochondria. Such a local disorganization of the peripheral SER in the distal part of the axons, could be responsible for the focal stasis of fast transported proteins; it seems to be one of the earliest changes detectable in axons damaged by acrylamide treatment.

Study of axonal dystrophy. II Dystrophy and atrophy of the presynaptic boutons: a dual pathology

In succession to the previous quantitative work, a qualitative study has been carried out on the nature of a dual pathology affecting presynaptic boutons in the posterior tract nuclei of ageing rats. Based on the morphology of dystrophic boutons in early stage, it is concluded that the initial and therefore essential characteristic of dystrophic process is an abnormal increase of normal axonal components within the presynaptic boutons, and that various abnormal substructures of spheroids hitherto reported in the literature are probably the results of their secondary metamorphosis. The dystrophic process within the posterior tract nuclei is a selective one, involving presynaptic boutons and preterminal axons only of the posterior tract fibres. Comparison of the frequency of early dystrophic boutons and of fully grown-up spheroids indicates that a small percentage of boutons deriving from posterior tract fibres become dystrophic and of these dystrophic boutons only a small percentage again continue to develop unto large spheroids, throughout lifespan of the animals. On the other hand, in search of a morphological counterpart for the age-related decrease of volume ratio of presynaptic boutons to the neuropil, some dubious atrophic changes were also found in presynaptic boutons, which could have been easily missed from observation if studied qualitatively alone. Accordingly, no less numerous boutons other than dystrophic ones are supposed to atrophy 'independently' and to disappear 'silently' during the same period. The dystrophic and the atrophic changes involve different boutons (of different or the same terminal axons) within the same gray matter. This dual pathology of boutons needs further elucidation of its neurocytopathological as well as neurobiological background in the future.

Morphological investigations on axonal swellings and spheroids in various human diseases

Axonal swellings and spheroids in various human diseases were studied by light and electron microscopy. 4 cases of infantile neuroaxonal dystrophy, 2 of degenerative diseases, 2 brain tumors and 3 of cerebrovascular disease were examined. Ultrastructurally most spheroids in infantile neuroaxonal dystrophy consisted of interconnected tubules, stacked membranotubular profiles, alternating layered membranes and accumulations of neurofilaments. Combinations of these four constituents were seen only in infantile neuroaxonal dystrophy. "Torpedos" (fusiform swelling of the axon of a Purkinje cell) consisted exclusively of neurofilaments. Spheroids in case 6 (mental retardation) and 7 (atypical teratoma) consisted of interwoven skeins of neurofilaments and grouped mitochondria. Spheroids in case 8 (demyelination) and 9 (cerebrovascular disease) consisted of packed complex bodies and mitochondria. Spheroids in cases 10 and 11 (cerebrovascular disease) consisted of degenerating organelles only. The morphological differences between cases 9, 10 and 11 probably depends on the severity and timing of the cerebral injury. Most spheroids show similar histological and histochemical properties, but ultrastructural study may give some clue to the origin of the bodies.

Diagnosis of infantile neuroaxonal dystrophy by conjunctival biopsy

Conjunctival biopsy and ultrastructural examination of conjunctival nerves, showing the presence of spheroids within axons, led to the confirmation of the diagnosis of infantile neuroaxonal dystrophy in two children with progressive mental deterioration. Conjunctival biopsy, which is simple to perform, even in young children, and does not require general anaesthesia or admission to hospital, is presented as a reliable and very convenient technique for the diagnosis of infantile neuroaxonal dystrophy.

Juvenile neuroaxonal dystrophy: clinical, electrophysiological, and neuropathological features

We describe 2 brothers with progressive myoclonus epilepsy that began in the second decade and was associated with cerebellar ataxia and intellectual deterioration. Electroencephalographic and cerebral evoked potential studies showed findings associated with myoclonus epilepsy. Neuropathological examination of 1 of the brothers, who died at age 23 years, revealed widespread changes of neuroaxonal dystrophy without pigment deposition in the basal ganglia. We propose the term juvenile neuroaxonal dystrophy (JNAD) to distinguish this condition on clinical grounds from infantile neuroaxonal dystrophy on the one hand, and on clinical and pathological grounds from Hallervorden-Spatz disease on the other hand. JNAD, while exceedinly rare, must be considered in the differential diagnosis of the progressive myoclonus epilepsies.

Infantile neuroaxonal dystrophy. Schwann cell inclusion in the peripheral nerve

Abnormal Schwann cell inclusion is reported in biopsied peripheral nerve in a case of infantile neuroaxonal dystrophy. In addition to non-specific dystrophic changes of the axons, the Schwann cells contained several distinct bodies which were composed of stacks of irregularly disposed membranes; in some instances, transformed Schwann cell cytoplasm was distined with similar bodies. This change has not been reported on this condition and its significance is briefly discussed.

Generalized giant axonal neuropathy: a filament-forming disease of neuronal, endothelial, glial, and schwann cells in a patient without kinky hair

The process of Giant Axonal Neuropathy (GAN) is not restricted to the peripheral nerves, but also involves the central nervous system. In a 25 year old man with normal hair, abundant axon swellings and spheroids were observed in the spinal cord, brain system, and cerebral cortex. The findings in the sural nerve have already been published by Boltshauser et al. (1977). Accumulations of filaments in the axons and in the perineural cells were accompanied by Rosenthal fibres. The ultrastructural pattern of GAN differs clearly from that of Neuroaxonal Dystrophies.

Cerebral cortical isolation in infantile neuroaxonal dystrophy

Three patients with infantile neuroaxonal dystrophy (INAD, Seitelberger's disease) studied between ages 2 and 5 years, with the characteristic electroencephalographic pattern of high-voltage, fast (16-24 c/sec) rhythms and absence of reactivity on eye-opening or closure (Radermecker and Dumon-Radermecker 1972), also showed no changes in response to intermittent photic stimulation and absence of evoked potentials to flashes, clicks or median nerve stimuli. Although some theta rhythms and delta activity appeared during drowsiness and sleep, the fast rhythms persisted as the dominant feature. There were no central transients or K-complexes. When the patients cried, with hyperventilation, and also during breath-holding spells, slow rhythms appeared and the fast rhythm was reduced. These findings are interpreted as evidence of cerebral cortex isolation, the fast rhythm representing the spontaneous ("idling") activity of the cortex largely disconnected from subcortical or remote cortical influences by the slowly progressive, selective degeneration of axons, characteristic of the pathology of INAD, but the cortex remains responsive to chemical influences. These electrophysiological features become established furing the third year of age, prior EEGs being normal and later ones showing paroxysmal and other abnormal features in addition to the fast rhythm.

Pallido-nigro-luysial atrophy associated with degeneration of the centrum medianum. A clinicopathologic and electron microscopic study

A 66-year-old man (case 1) and a 71-year-old woman (case 2) showed systemic degeneration of the globus pallidus, substancia nigra, subthalamic nucleus, centrum medianum thalami and at times, superior colliculus in the midbrain. In the pallido-nigral system, neuronal loss was severe in both cases and an increase of pigment and granular spheroids was marked in case 2, less in case 1. Electron-microscopically, the spheroids consisted of aggregates of highly dense material, often membrane-bound, and varying amounts of groups of loosely packed filaments. Clinical symptoms were stereotyped and unique, showing severe akinesia, no rigidity in the limbs, no tremor but retropulsions, upward gaze palsy, dysarthria, dysphagia and later, nuchal stiffness. Nosological identification is discussed.

Infantile neuroaxonal dystrophy. Ultrastructural study of peripheral nerve

Ultrastructural study of the biopsied sural nerve in a case of infantile neuroaxonal dystrophy was made. The characteristic change in the ballooned axons is an accumulation of membranous profiles associated with mitochondria, glycogen like granules, dense bodies, vesicles and electron lucent material. The membranous profile is classified into three morphological types and discussed on each of them. Probably tubulomembranous profile of the first type is most common and may be cardinal deposit in this condition. These membranous structures of various types might be, however, only different manifestations occurring on the same morbid process. Enormous amount of glycogen like granules and mitochondria might be related to the metabolic derangement of carbohydrate in the ballooned axons. Electron lucent material we observed was not described in the previous papers on this condition. We added one more example showing that nerve biopsy is helpful to confirm the diagnosis in infantile neuroaxonal dystrophy.

Infantile neuroaxonal dystrophy. An electron microscopic study of a case clinically resembling neuronal ceroid-lipofuscinosis

An unusual case of infantile neuroaxonal dystrophy (INAD) in which seizures were the presenting and predominant clinical feature is described. Although the clinical manifestations were indistinguishable from neuronal ceroid-lipofuscinosis, the diagnosis was readily established by electron microscopic examination of the brain biopsy specimen. Even after the ultrastructural features were known, the dystrophic axons were not evident by light microscopy. This case broadens the clinical picture of INAD to include seizures as the presenting complaint and suggests that some patients with childhood epilepsy who "deteriorate" may have this genetically determined disease.

Infantile neuroaxonal dystrophy (Seitelberger's disease). A light and ultrastructural study

The findings in a case of infantile neuroaxonal dystrophy are presented. Light microscopy shows wide distribution of spheroids, cerebullar atrophy and striatal degeneration. Electron microscopy shows numerous spheroids consisting of tubulo-vesiculo-membranous profiles. The dystrophic changes appear first in the axon seem to be modified by axostasis and/or transneuronal degeneration in addition to the dystrophic changes. The participation of the endoplasmic reticulum and microtubules in spheroid formation and their relation to the malformation of the synaptic vesicles have been discussed. Diverse mitochondrial abnormalities and Hiranolike body are also described.