The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans.

The hyaline inclusions in the pigmented ganglion cells of the substantia nigra and the locus coeruleus in patients suffering from idiopathic paralysis agitans are known as Lewy bodies after their discoverer, Lewy (1913). A detailed description of these bodies was presented by Greenfield and Bosanquet in 1953. The intracytoplasmic bodies are always surrounded by a light halo, and often have a central core which stains differently from the remainder of the body. If these morphological and staining characteristics are taken into account, confusion with other cytoplasmic inclusions is impossible. Greenfield and Bosanquet found Lewy bodies in each of their 19 cases of idiopathic paralysis agitans, and in none of their 10 cases of postencephalitic Parkinsonism or in their 22 control cases. These findings were confirmed by Bethlem and den Hartog Jager (1960) in 15 cases of idiopathic paralysis agitans, four cases of post-encephalitic Parkinsonism, and 20 control cases. We have since found the Lewy bodies in nine new cases of Parkinson's disease. We failed to find them in a case of Parkinson following CO intoxication and in the case of Friedreich's ataxia combined with hereditary Parkinsonism, previously described by Biemond and Sinnege (1955). In contrast with the above are the findings of Redlich (1930) and Godlowski (1931), each of whom found Lewy bodies in two cases of post-encephalitic Parkinsonism. Alvord (1958) described Lewy bodies in four out of 14 post-encephalitic cases. Lipkin (1959) also found Lewy bodies in four out of nine verified cases of post-encephalitic Parkinsonism. Lewy bodies have so far been chiefly described in the pigmented ganglion cells of the substantia nigra and the locus coeruleus (Tretiakoff, 1919; BeheimSchwarzbach, 1952; Greenfield and Bosanquet, 1953). Lewy himself (1913, 1923) described these bodies in the nucleus of the substantia innominata, the periventricular nucleus, and the dorsal vagal nucleus. Von Buttlar-Brentano (1955) found Lewy bodies in the nucleus of the substantia innominata (nucleus basalis) in each of 16 cases of paralysis agitans. In 13 cases of post-encephalitic Parkinsonism, no Lewy bodies were found in this nucleus. Bethlem and den Hartog Jager found Lewy bodies in the nucleus of the substantia innominata in nine out of 15 cases of Parkinson's disease. Greenfield and Bosanquet described Lewy bodies as found in the oculomotor nucleus (Case 9) and in the nucleus of Roller (Case 10) in idiopathic paralysis agitans. In idiopathic paralysis agitans, Lipkin found Lewy bodies in the ganglion cells of the dorsal vagal nucleus (three cases), the cerebral cortex (one case), and the inferior olive (one case). Herzog (1928), Wohlwill (1928), and Hechst and Nussbaum (1931) found Lewy bodies in the ganglion cells of the sympathetic vertebral chain in paralysis agitans, and were therefore the first investigators to encounter Lewy bodies outside the central nervous system. They do not indicate whether Lewy bodies were also present in the central nervous system in these cases. They did report having found Lewy bodies in the sympathetic ganglia in patients not suffering from paralysis agitans, although of considerably less marked intensity and spread. The purpose of this paper is to present a description of the exact distribution of Lewy bodies in Parkinson's disease, both in the central and in the peripheral autonomic nervous systems.