Few detailed clinico-pathological correlations of Parkinson's disease have been published. The pathological findings in 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease are reported. Seventy six had nigral Lewy bodies, and in all of these Lewy bodies were also found in the cerebral cortex. In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.

https://jnnp.bmj.com/content/jnnp/55/3/181.full.pdf

Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.

Parkinson's disease: Mechanisms and models

The ascending monoamine pathways in the rat brain are demonstrated by the pile up of fluorescent material occurring in the axons after various types of lesions. The anatomy of the pathways is outlined in drawings of frontal sections of the brain and the origin and termination of several pathways is determined by studying the anterograde and retrograde degeneration occurring after well localised lesions. It is possible to separate the ascending NA pathways into a dorsal and a ventral bundle of axons. The dorsal bundle innervates the cortex and the hippocampus and the ventral bundle supplies NA nerve terminals to the medulla, the pons, the mesencephalon and the diencephalon. The dorsal bundle is found to originate in the locus coeruleus. Lesions of this nucleus abolish the nerve terminals in all cortical areas and in several other areas of the brain indicating a unique role for the locus coeruleus in influencing the activity of the entire brain. The 5-HT pathways have a distribution similar to the ventral NA pathyway. The course of the nigro-striatal and the meso-limbic DA pathways is presented in detail.

Stereotaxic mapping of the monoamine pathways in the rat brain.

The Lewy body is a distinctive neuronal inclusion that is always found in the substantia nigra and other specific brain regions in Parkinson's disease. It is mainly composed of structurally altered neurofilament, and occurs wherever there is excessive loss of neurons. It occurs in some elderly individuals and rarely in other degenerative diseases of the central nervous system. In 273 brains of patients dying from disorders other than Parkinson's disease, the age-specific prevalence of Lewy bodies increased from 3.8% to 12.8% between the sixth and ninth decades. Associated pathological findings suggest that these cases of incidental Lewy body disease are presymptomatic cases of Parkinson's disease, and confirm the importance of age (time) in the evolution of the disease. In view of the common and widespread occurrence of this disorder we propose that endogenous mechanisms operating in early life may be more important than environmental agents in the pathogenesis of Lewy bodies and Parkinson's disease.

https://jnnp.bmj.com/content/jnnp/51/6/745.full.pdf

The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease.

Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations.

Protracted post-traumatic encephalopathy. Pathology, pathogenesis and clinical implications.

Es wird uber einen 51jahrigen Mann berichtet, der wegen eines Hemiparkinson innerhalb von 1 1/2 Jahren 7 Hirntrockenzelleninjektionen a 0,02 erhielt, 22 Tage nach der letzten Injektion akut erkrankte und nach 7 Wochen unter den Zeichen eines rasch progredienten cerebralen Prozesses starb. Pathologisch-anatomisch handelte es sich neben typischen Veranderungen eines endogen-degenerativen Morbus Parkinson um das Bild einer akuten Entmarkungs-Encephalitis mit machtigen periventrikularen Herden, multiplen kleinen perivascularen Lasionen im Groshirnmark und vereinzelten Rindenherden. Die Erkenntnisse der experimentellen Entmarkungsforschung und analoge neuropathologische Beobachtungen uber die Folgen von Lyssaschutzimpfungen sowie deren kritische Anwendung auf bestimmte Erfahrungen der primaren Entmarkungserkrankungen des Menschen berechtigen zur Feststellung eines kausalpathogenetischen Zusammenhanges zwischen den wiederholten parenteralen Applikationen von tierischem Hirngewebe und dem Auftreten der Entmarkungs-Encephalitis im Sinne eines immunochemischen Geschehens. Gegen die parenterale Verabreichung von substantiellem Hirngewebe zu therapeutischen Zwecken werden daher begrundete Bedenken vorgebracht.

F. Seitelberger

Papers

Brain dopamine and the syndromes of Parkinson and Huntington. Clinical, morphological and neurochemical correlations.

Protracted post-traumatic encephalopathy. Pathology, pathogenesis and clinical implications.

Acute fatal demyelinizing encephalitis after repeated injections of dry brain cells

Verhalten des Dopamins (=3-Hydroxytyramin) im Nucleus caudatus nach elektrischer Koagulation des Globus pallidus