Fig. 4

Microscopic findings. The spinal cord showed bilateral decreases in myelin staining in the corticospinal tract, the posterior spinocerebellar tract, the posterior column including the gracile fasciculus and the intermediate root zone, and the anterolateral funiculus (A). Marked neuronal loss and gliosis were observed in the spinal cord anterior horn (low-power field with Klüver-Barrera staining, B; high-power field with haematoxylin-eosin staining, C). Onuf’s nucleus (D) and Clarke’s column (E) also showed severe neuronal loss and gliosis. Coarse eosinophilic granules were observed in a cervical spinal cord anterior horn cell (F). These eosinophilic inclusions were immunoreactive for p62 (G). The corpus callosum was very thin (H) and exhibited gliosis, but slight axonal staining remained (I, J). The precentral gyrus showed moderate neuronal loss and gliosis, and Betz cells became so atrophic that they were difficult to identify (K). The lateral geniculate body showed marked neuronal loss and gliosis in all layers (low-power field with Klüver-Barrera staining, L; high-power field with haematoxylin-eosin staining, M; high-power field with p62 immunostaining, M inset), and Lewy body-related α-synucleinopathy was abundant in the dorsal motor nucleus of the vagus nerve (N). Scale bars: 2 mm (A); 500 μm (B, L); 100 μm (C–E, I–K, M); 20 μm (F, G, M-Inset, N); 5 mm (H)