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Cerebrovascular disorders — Clinical and research classification
Journal of the Neurological Sciences, 1980, 45: 177-190
177
© Elsevier/North-Holland Biomedical Press
BERIBERI N E U R O P A T H Y Morphometric Study of Sural Nerve
AKIO OHNISHI1, SADATOSHI TSUJI 2, HIDEKI IGISU 2, YOSHIYUKI MURAI 2, IKUO GOTO 2, YOSHIGORO KUROIWA 2, MITSUHIRO TSUJIHATA a and MASAI-IARU TAKAMORI a Departments of 1Neuropathology and zNeurology, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka and aDepartment of Internal Medicine, Faculty of Medicine, Nagasaki (Japan)
(Received 30 May, 1979) (Revised, received 10 October, 1979) (Accepted 17 October, 1979)
SUMMARY Seven biopsied sural nerves from patients with beriberi were morphometrically evaluated. In teased fiber analysis the mean frequency of myelinated fibers showing axonal degeneration and segmental demyelination was 37.5 and 5.3 ~ , respectively. In two cases with frequency of segmental demyelination higher than 5 ~ , segmental demyelination was shown by statistical criteria to have occurred on certain fibers in a clustered fashion. Therefore, the segmental demyelination in beriberi may be secondary to axonal degeneration. Electromyographic findings and slow improvement of muscle weakness were compatible with axonal degeneration of motor fibers. Determinations of fiber densities revealed preferential decrease of the density of large myelinated fibers with the preservation of the density of small myelinated and unmyelinated fibers. The preferential nerve fiber involvement in beriberi was not associated with pain in the lower limbs and this fact is contrary to the expectation of the proponents of the gate control theory.
INTRODUCTION Recently we encountered cases of sensorimotor neuropathy with cardiac enlargement and edema of the feet affecting young males. Based on clinical and laboratory examinations this was diagnosed as beriberi neuropathy, which had disappeared from neurological practice in Japan. Although the pathology of the peripheral nerve in beriberi has been extensively studied (Baelz 1882; Scheube 1884; Pekelharing and Winkler 1887; Miura 1909; Takahashi and Nakamura 1976), further study by new
177
© Elsevier/North-Holland Biomedical Press
BERIBERI N E U R O P A T H Y Morphometric Study of Sural Nerve
AKIO OHNISHI1, SADATOSHI TSUJI 2, HIDEKI IGISU 2, YOSHIYUKI MURAI 2, IKUO GOTO 2, YOSHIGORO KUROIWA 2, MITSUHIRO TSUJIHATA a and MASAI-IARU TAKAMORI a Departments of 1Neuropathology and zNeurology, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka and aDepartment of Internal Medicine, Faculty of Medicine, Nagasaki (Japan)
(Received 30 May, 1979) (Revised, received 10 October, 1979) (Accepted 17 October, 1979)
SUMMARY Seven biopsied sural nerves from patients with beriberi were morphometrically evaluated. In teased fiber analysis the mean frequency of myelinated fibers showing axonal degeneration and segmental demyelination was 37.5 and 5.3 ~ , respectively. In two cases with frequency of segmental demyelination higher than 5 ~ , segmental demyelination was shown by statistical criteria to have occurred on certain fibers in a clustered fashion. Therefore, the segmental demyelination in beriberi may be secondary to axonal degeneration. Electromyographic findings and slow improvement of muscle weakness were compatible with axonal degeneration of motor fibers. Determinations of fiber densities revealed preferential decrease of the density of large myelinated fibers with the preservation of the density of small myelinated and unmyelinated fibers. The preferential nerve fiber involvement in beriberi was not associated with pain in the lower limbs and this fact is contrary to the expectation of the proponents of the gate control theory.
INTRODUCTION Recently we encountered cases of sensorimotor neuropathy with cardiac enlargement and edema of the feet affecting young males. Based on clinical and laboratory examinations this was diagnosed as beriberi neuropathy, which had disappeared from neurological practice in Japan. Although the pathology of the peripheral nerve in beriberi has been extensively studied (Baelz 1882; Scheube 1884; Pekelharing and Winkler 1887; Miura 1909; Takahashi and Nakamura 1976), further study by new