Peripheral nerve abnormalities related to galactose administration in rats.

Electrophysiological, biochemical, and morphometric observations were made on the peripheral nerves of rats after galactose feeding. Motor nerve conduction velocity was found to be reduced. This was associated with an accumulation of galactitol in the peripheral nerves and a diminution in their myoinositol content. An increased water content and fascicular area, taken in conjunction with a probable increase in the area of the endoneurial spaces, indicated overhydration of the peripheral nerves. Morphometric observations on the myelinated fibre population in the tibial nerve showed no loss of fibres and although both the maximal and the average diameter of the myelinated fibres was slightly less than in age-matched controls, this was insufficient to explain the reduction in conduction velocity. Segmental demyelination was not detected and the relationship between myelin thickness and axon circumference was not altered. Electron microscope observations revealed no ultrastructural changes in the myelinated fibres and, in particular, no abnormalities at the nodes of Ranvier or indication of abnormal hydration of the Schwann cells. The relevance of these findings to the peripheral nerve changes in human and experimental diabetes is discussed.     

Peripheral nerve abnormalities of mutant (PMA) mouse--myelinated fiber counts of sciatic, peroneal, sural and tibial nerves

A mutant mouse characterized by peroneal muscular atrophy and congenital absence of the peroneal nerve has been described by Esaki et al. and investigated as a possible animal model of Charcot-Marie-Tooth disease or spinal muscular atrophy. However, the nature of the peripheral nerve abnormality of this mutant mouse has not been precisely defined yet. In this study, in addition to the qualitative evaluation of teased fiber and Epon-embedded preparations, the total transverse fascicular area and the total numbers of myelinated fibers per nerve in sciatic, peroneal (proximal and distal), sural (proximal and distal) and tibial (proximal and distal) nerves on both right and left sides were compared between six peroneal muscular atrophy (pma) mice with autosomal recessive gene manifesting mainly the peroneal muscular atrophy and their six control mice to understand and define the peripheral nerve abnormalities. The pma mice showed pes equinovarus bilaterally and their peroneal nerves were absent. No myelinated fibers showing axonal degeneration or segmental demyelination were found on teased fiber preparation. Onion bulb, demyelinated or remyelinated axons and myelin ovoids were not observed in Epon-embedded sections. The mean total transverse fascicular area and mean total number of myelinated fibers per nerve in the sciatic nerve in pma mice was significantly less (p less than 0.02) than that in control mice. On the other hand they were significantly greater (p less than 0.0001) in the sural nerve in pma mice than in control mice.(ABSTRACT TRUNCATED AT 250 WORDS)     

The density of myelinated fibres is related to the fascicle diameter in human superficial peroneal nerve. Statistical study of 41 normal samples

The density of myelinated fibres in the superficial peroneal nerve was studied in 41 samples from 24 control human subjects. Photographic montages of the whole nerve fascicle were made from semithin and ultrathin transverse sections and used for a statistical analysis of sampling procedures, range of variations and relations between density and other variables. The results indicate that the spatial distribution of myelinated fibres within a nerve is often non-uniform. Therefore, it was not possible to define a statistically valid sampling system. The study of relations between variables shows the lack of any correlation between density and age and a considerable variation in the density. In contrast, there is a strong positive linear correlation between the surface area of the nerve fascicle and its content of myelinated fibres. That is, the fibre density of a given normal nerve is related to its diameter and can be predicted within a narrow range of error. We propose the term "derived density" for this value, and its application as a tool in the diagnosis of peripheral neuropathies is now being studied.     

Accuracy of the three-window sampling method in morphometric analysis of human sural nerve

Morphometry has an important role in the assessment of sural nerve biopsies as a part of early detection of structural abnormalities in peripheral nerve. Various sampling methods have been used to reduce time and effort needed in the analysis of total nerve fibers but their accuracy remains controversial. We examined the accuracy of three-window sampling method in the morphometric evaluation of human sural nerve biopsies by comparing with the total fiber quantification. Three windows (0.012 mm(2) each) were placed in every possible fascicle in the sections and data from all windows were pooled and analyzed for the number of myelinated axons, myelinated fiber diameter, axon diameter, myelin thickness, g ratio as well as myelinated fiber density. Means and ranges of the data from the two techniques were similar and the agreement was further confirmed by intraclass correlation analysis. These findings indicate that the three-window sampling method can be used to evaluate human sural nerve with accuracy.     

There is no simple adequate sampling scheme for estimating the myelinated fibre size distribution in human peripheral nerve: a statistical ultrastructural study

Morphometric studies of peripheral nerves (PN) usually involve some sampling of the myelinated fibres (MF). In order to scrutinize the statistical properties of the sampling processes in common use and the reliability of the resulting estimates, a quantitative analysis of human superficial peroneal nerves from 8 different normal subjects was undertaken at the ultrastructural level, both in terms of MF spatial distribution and of their size distribution. This study used sampling rates involving more than 10% of the whole myelinated fibre population observed in each nerve fascicle. However, in nearly all the fascicles evaluated, the sampling fluctuations are so high that neither the number of axons nor their diameter distribution can be assessed with enough accuracy. A systematic study of the myelinated fibres shows that the spatial distribution of their size is not uniform. This marked heterogeneity in the MF size distribution imposes measurement of large enough samples (500 or 600 MFs usually represent about one-half or two-thirds of the whole MF population) in a way to secure a reliable enough estimate of the density and size distributions. However, the practical usefulness of sampling schemes requiring more than one-half of the whole MF population in a nerve fascicle, is questionable.     

The syndrome of continuous muscle fibre activity: light and electron microscopic studies in muscle and nerve biopsies

Summary Histological and ultrastructural studies were performed on nerve and muscle biopsy specimens from two patients with the syndrome of continuous muscle fibre activity. The characteristics of muscle biopsies were as follows. By light microscopy, internal nuclei were present in many of the fibres. By electron microscopy many fibres contained filamentous bodies and subsarcolemmal aggregates of mitochondria embedded in the peripheral zone of cytoplasm, and occasional mitochondria with disorganized or branched cristae were larger than normal. Biopsies of sural nerves revealed a decreased number of myelinated fibres, clusters of small myelinated fibres, and evidence of active axonal degeneration such as disintegrated myelin segments and degenerated axon components, as well as loss of axonal contents. With the present biopsy findings, it is suggested that the pathological process of this syndrome affects peripheral nerves as well as muscles.     

Axonal degeneration in large and small nerve fibres. An electron-microscopic and morphometric study

Using computer-aided morphometric methods, axonal degeneration following nerve crush was analysed to reassess whether small fibres degenerate before large fibres or vice versa, or simultaneously. Axonal microtubule density was used as the criterion for determining the extent of fibre degeneration. Axonal areas and axonal microtubule numbers were recorded from a large sample of myelinated fibres in the right unoperated rat sural nerve and distal to crush in the left sural nerve. Both samples were divided into small and large fibre groups, according to axonal areas. Statistical analysis of the data confirmed a significant loss of microtubules from the left crushed nerve fibres but no significant difference in the relative loss of microtubules from small and large fibres. It is concluded, therefore, that in Wallerian degeneration, axonal breakdown, as assessed by microtubule loss, occurs simultaneously in small and large fibres. The findings are related to the electrophysiological changes which occur in Wallerian degeneration.     

A pathologic study of the vagus nerves in diabetes mellitus

A systematic morphometric examination at different levels of the vagus nerves obtained at autopsy in 4 control subjects and 3 diabetics was carried out. Morphometric studies on myelinated fibres were performed on the nerve at mid-cervical, lung hilum and diaphragmatic levels. In 2 insulin-dependent diabetics the density of myelinated fibres was below the lower limit of the control range at all levels. In all the diabetic subjects there was significant reduction in the density of fibres at the most distal level in the nerves. The teased fibre studies showed predominantly changes of axonal degeneration. They are consistent with the findings of abnormal vagal function in diabetics.     

The normal sural nerve in man

Summary A combined light and electron microscope study of the normal sural nerve in 7 people aged 15–59 years is reported. Qualitative and quantitative studies of the Schwann cells and fibroblasts, myelinated and unmyelinated fibres are made in isolated fascicles.Schwann cells predominate over fibroblasts in the ratio of about 9-1. Most Schwann cells, almost 80%, are attached to unmyelinated fibres. Factors influencing the densities of these cells per cross sectional area are discussed.Some ultrastructural features of the myelinated fibres are described and their numbers per sq.mm and frequency distribution of their sizes are produced. An indirect method is proposed for assessing the mean internodal length for earch of the myelinated fibre size populations in cross sections of fascicles of normal nerves by estimating the proportion of myelinated segments cut through their nucleus.The ultrastructure of unmyelinated fibres is described and the identification of axons of extreme diameter is discussed. Their densities and size frequency histograms are the first to be reported in man by systematic electron microscope studies. The average ratio of unmyelinated to myelinated fibre density is about 3.7:1 though it varies in the fascicles of the different individuals.The implications of axonal diameter in the presence of myelin are commented on.British Council Scholar on leave of absence from Escuela de Medicina, Universidad Austral, Valdivia, Chile.     

VARICOSITIES IN HUMAN FETAL SCIATIC NERVE FIBRES

A morphological study performed on sciatic nerves from 10 fetuses aged 19 to 32 weeks revealed variations in axonal diameter along the length of the fibres but a uniform myelin sheath thickness. This gave the fibres a beaded appearance. The diameter of the axon in the varicosities was up to seven-times greater than that of the intervening axon. The varicosities were separated by distances up to 50 microns. Both myelinated and single unmyelinated fibres had varicosities. Neurofilaments and neurotubules were more densely packed in the axons between the varicosities. The absolute number of filaments and tubules per axon was similar in axons with equal numbers of myelin lamellae but with different diameters, as calculated from transverse sections. The varicosities were observed in all fetuses aged 19 to 24 weeks, but in only one of the two fetuses aged 28 weeks. They were not present in the 32 week fetus. They appear to be a characteristic morphological feature of nerve fibres during early fetal life and can be identified only in teased fibre preparations or in longitudinal sections of the nerve. Their presence explains the bimodal or markedly skewed distribution of myelinated fibre axon diameters that was seen in nerves from young fetuses. It also helps in understanding the discrepancies reported in size patterns between axon diameter and myelin thickness. It is possible that the varicosities may be partially artefactual but their occurrence may imply a particular vulnerability of fetal nerve fibres. Their production may be related to movements of the axoplasmic fluid which is abundant in young fetuses.     

Late changes in human sural nerves in minamata disease and in nerves of rats with experimental organic mercury poisoning

Summary The sural nerves of 2 human cases with Minamata disease and poisoned rats were examined histopathologically. Both showed similar findings: the myelinated nerve fibres were decreased in number, but small myelinated nerve fibres were increased: The latter were irregular in shape and their Schwann cells showed regressive changes, with high electron density of the cytoplasms and many glycogen granules. Onion, bulb formation was not found. According to fibre diameter histograms, the ratio of small myelinated nerve fibres of 2–5 m showed a high percentage. A large number of the small myelinated nerve fibres were presumed to be regenerated nerve fibres. These findings are different from other peripheral neuropathies and may be characteristics of the late changes of the sural nerve induced by organic mercury compound.     

Friedreich's ataxia: electrophysiological and histological findings

ABSTRACT- Electromyography was performed, and motor and sensory nerve conduction velocities were measured in 19 patients definitely affected by Friedreich's ataxia. Biopsy of the sural nerve was also performed in 9 patients.
Most patients presented a moderate to severe loss of motor units, a significant increase in mean duration of motor unit potentials, and in the incidence of polyphasic potentials. Short-lasting spontaneous activity was rarely seen. Conduction velocity along the motor and sensory fibres of the median and tibial nerves was moderately slowed, while distal conduction time to muscle was significantly increased and the sensory orthodromicallyevoked response markedly reduced. Intraoperative electrophysiological recordings obtained during biopsy of the sural nerve in 4 patients were consistent with the changes conventionally observed in the median, tibial and sural (6 patients) nerves.
Quantitative histology revealed a reduced number of total myelinated fibres with a severe loss of large fibres, and a moderate loss of fibres of less than 7 μm in diameter. In teased nerve fibre preparations, the most evident abnormality consisted of fibres with uniformly short internodal length, while signs of remyelination were less prominent. Signs of active axonal degeneration were rarely observed in electron microscopy.
Electrophysiological and histological findings were uniformly distributed, and the changes were neither related to the duration nor to the severity of the clinical condition.     

Morphometric studies of sural nerve in childhood

Sural nerve myelinated fiber density and myelinated fiber diameter distribution have been examined in 27 control subjects, ranging in age from 1 day to 59 years. Total transverse fascicular area was measured in 10 of the subjects. There is an exponential decline in myelinated fiber density from birth to adult life. The predicted normal density (D) at any age may be derived from the formula D = (1 X 10(3]/(0.0699 + 0.00725 square root t). The distribution of myelinated fiber diameters is unimodal in the first 4 months of life, and there is a definite bimodal distribution by 2 years of age. Total transverse fascicular area of sural nerve increases progressively from values of about 0.25 mm2 in the first week to about 0.82 mm2 at 9 years. Control values for sural nerve morphometry in childhood are essential for accurate interpretation of biopsies in patients with peripheral neuropathy.     

Author index (vol. 54)

Two patients in whom polyneuropathy was associated with hypothyroidism have been studied clinically and electrophysiologically. Sural nerve biopsy was performed on both patients and the nerve studied by light and electron microscopy. Both patients had symptoms of paraesthesiae and muscle pain and there was distal weakness, sensory impairment and incoordination in both upper and lower limbs. Gait was impaired and tendon reflexes were depressed. Electrophysiological studies demonstrated moderate slowing of motor conduction velocity and absent sensory potentials. Microscopic studies of the sural nerves revealed a loss of myelinated fibres of all diameters but particularly those of large diameter. On teased fibre examination, the predominant abnormality was axonal degeneration and electron microscopy showed degenerating fibres, prominent cluster formations, abnormalities of mitochondria and prominent glycogen deposits within Schwann cells. Quantitative study of unmyelinated fibres indicated a relative increase in fibres of small diameter. It is concluded that the polyneuropathy associated with hypothyroidism is due largely to axonal degeneration.     

Comparative morphometry of myelinated nerve fibres in the normal and pathologically altered human sural and tibial nerve

To assess neuropathological changes in human nerves, biopsies are usually performed on the sural nerve or other nerves supplying only a small area of skin. It is not yet clearly understood to what extent the changes found in this sensory nerve correspond to the changes found in other distal sensomotory nerves. To answer this question, we made a comparative morphometric analysis of the sural and tibial nerve. In 39 autopsy cases (aged 22 - 90 years) the sural and the tibial nerve were subject of image analysis. The histological picture in this study group was clearly influenced by neuropathological changes as well as age-related changes. For each morphometric parameter in the sural and tibial nerve, we evaluated Pearson's correlation. The highest coefficient of correlation (r) was seen in those parameters that represented the condition of the myelin sheath area: the density of nerve fibre area (sum of measured nerve, fibre areas/analyzed endoneural area) (r = 0.86) and the density of myelin sheath area (sum of measured myelin areas/analyzed endoneural area) (r = 0.86). Similar correlations were obtained for the mean of axon diameter (r = 0.82), the numerical density of nerve fibre count (nerve fibre count/analyzed endoneural area) (r = 0.77), the mean of nerve fibre diameter (r = 0.77) and the mean of myelin sheath thickness (r = 0.72). Our results revealed a good or very good statistical correlation of morphometric parameters between the two examined nerves. They support the assumption that the sural nerve sufficiently reflects the histological changes in other distal sensomotoric nerves. This is valid at least in systemic neuropathological diseases and age-dependent processes.     

The relationship between axon diameter, myelin thickness and conduction velocity during atrophy of mammalian peripheral nerves

The atrophy of cutaneous (sural) and muscle (medial gastrocnemius) nerves proximal to a ligation were studied in cats for periods up to 9 months, using light and electron microscopy, conduction velocity measurements and computer simulations. As atrophy proceeds, nerve fibres become increasingly non-circular. Cross-sectional areas of axons and fibres (axon + myelin) were measured. The diameters of equivalent circles (having the same axon and fibre cross-sectional area) were then calculated. A linear relation was found between axon diameter and fibre diameter, but the slope decreased as atrophy continued. This indicates that the axon cross-sectional area decreases relatively more than the total fibre area. Reduction in conduction velocity correlates more closely with reduction in axon diameter than fibre (axon + myelin) diameter.The ratio of the inner (axon) perimeter to the outer (myelin) perimeter remains constant at or near the optimal value of 0.6 for conduction in all groups of fibres at all periods of atrophy. Futhermore, the thickness of the myelin remains constant for a given perimeter over the entire period of atrophy studied. This suggests that the number of turns of myelin and the length of each turn remain unchanged during peripheral nerve atrophy. A simple geometric model explains how this can occur without gaps developing between the axon and myelin or between the turns of myelin. The Frankenhaeuser-Huxley equations for conduction in myelinated nerve fibres predict changes in conduction velocity similar to those observed, if the axons atrophy without changes in myelin. The advantages of this mode of atrophy are discussed.     

Neurogenic involvement in distal myopathy (Welander). Histochemical and morphological observations on muscle and nerve biopsies

Patients with distal myopathy (Welander) were subjected to muscle biopsy from the anterior tibial muscle (n = 4) and to nerve biopsy from the sural nerve at the ankle (n = 5) in order to elucidate a possible neurogenic component of the disease. The type I muscle fibres had a larger mean cross-sectional area as compared to normal controls and an increased variation in fibre size with both hypertrophic and atrophic fibres in one and the same biopsy. A normal muscle fibre type composition was found in the patients. Structural muscle fibre abnormalities such as atrophic fibres, mainly angulated, split fibres, rimmed vacuoles and centrally located nuclei were found in all biopsies. A disorganization and loss of myofibrils as well as autolytic vacuoles were the most prominent findings at the ultrastructural level. Two patients had a moderate loss of myelinated sural nerve fibres. The mean nerve fibre density was decreased as compared to normal controls while the mean nerve fibre area and circular diameter were increased due to selective loss of small diameter (A-delta) nerve fibres. The muscle and nerve fibre abnormalities are discussed with reference to neuropathic and myopathic changes. Some muscle fibre abnormalities are typical for a neurogenic disorder while some others are mostly seen in myopathies but may also appear in neurogenic conditions. A neurogenic etiology in Welander distal myopathy is further supported by the finding of loss of small diameter nerve fibres in the sural nerve.     

Quantitative and qualitative morphological properties of the soleus motor nerve and the L5 ventral root in young and old rats. Relation to the number of soleus muscle fibers

The motor nerve to the soleus muscle and the L5 ventral root from young adult (3-6 months) and old (20-25 months) male Wistar rats were studied with regard to total number of myelinated nerve fibres, calibre spectra of myelinated fibres and morphological properties. The soleus muscle was examined with respect to total number of muscle fibres. A significant decrease in the number of myelinated nerve fibres was found in the old soleus nerves, and was mainly confined to the large-diameter fibers. Similarly, there was a significant decrease in the number of large myelinated fibres in the L5 ventral roots of old animals. Morphological changes in old nerves and spinal roots consisted of axonal degeneration with areas devoid of myelinated nerve fibres, and also myelin sheath irregularities, including myelin splitting with myelin balloon formation, infolded myelin loops and myelin reduplication. The axonal degeneration was more pronounced in the peripheral nerves than in spinal roots. In conformity with other studies, the soleus muscle showed an age-related decrease in the number of muscle fibres. These findings indicate that the decrease in fibre number in old soleus muscle is associated with degenerative neuronal changes and loss of alpha-motoneurons.     

Sensory action potentials and biopsy of the sural nerve in neuropathy.

In 167 consecutive patients with various types of neuropathy, the amplitude of the sensory potential and the maximum conduction velocity along the sural nerve were compared with conduction in other sensory nerves, and were related to structural changes revealed by nerve biopsy. Electrophysiological findings in the sural nerve were similar to those in the superficial peroneal and the median nerve, though the distal segment of the median nerve was normal in 20 per cent of the patients when it was abnormal in the sural nerve. Quantitation of histological findings was a more sensitive method than the electrophysiological study in that two-thirds of 33 patients with normal electrophysiology in the sural nerve showed mild loss of fibres or signs of remyelination in teased fibres. The amplitude of the sensory potential was grossly related to the number of large myelinated fibres (more than 7 micrometer in diameter). Considering the 95 nerves from which teased fibres were obtained, maximum conduction velocity was abnormal in half. In 18 of these nerves, slowing in conduction was due to axonal degeneration: the velocity was as to be expected from the diameter of the largest fibres in the biopsy ("proportionate slowing"). In 9 nerves slowing was severe and more marked than to be expected from loss of the largest fibres ("disproportionate slowing"); these nerves showed paranodal or segmental demyelination in more than 30 per cent of the fibres. In 16 nerves from patients with neuropathy of different aetiology neither loss of fibres nor demyelination could explain the moderate slowing. The cause of slowing in these nerves is unknown; other conditions are referred to in which slowing in conduction cannot be attributed to morphological changes. Finally, electrophysiological and histological findings are reported in some patients with neuropathy associated with malignant neoplasm, with rheumatoid arthritis, with polyarteritis nodosa, with acute intermittent porphyria and with cirrhosis of the liver.     

Sensory neuropathy in infantile onset spinocerebellar ataxia (IOSCA)

Infantile onset spinocerebellar ataxia with sensory neuropathy is a new, inherited multisystem disorder discovered in 19 Finnish patients. In order to define the neuropathy of the disease, we measured sensory nerve action potentials and nerve conduction velocities in 18 patients, and recorded somatosensory evoked potentials (SEP) in 10 patients and performed a sural nerve biopsy in 13 patients. The fixed and teased nerve fascicles were examined by light and electron microscopy, and the whole transverse section of a nerve fascicle was photographed and enlarged for morphometric measurements. Our investigation revealed an early onset, rapidly progressive axonal neuropathy: the sensory action potentials were decreased after the age of 2 and a severe loss of mainly large myelinated fibers was found. © 1994 John & Sons, Inc.