Acta Neuropathologica

, Volume 38, Issue 2, pp 95–101 | Cite as

Quantitative changes of sural nerves in various neurological diseases

  • Hideo Tohgi
  • Hiroshi Tsukagoshi
  • Yasuo Toyokura
Original Investigations


Quantitative histological studies were made on sural nerve biopsies from 123 patients with various neurological disorders. The myelinated fibre density, nuclear density, and the thickness of the perineurium were measured and compared with the average and standard deviation of control material in different age groups.

Specimens from chronic polyneuritis and heredodegenerative neuropathy showed a reduction of myelinated fibres and an increase of nuclei, the decrease of large myelinated fibres being greater than that of small myelinated fibres.

In acute polyneuritis the large and small myelinated fibres decreased equally in number. In the sensory type of SMON, small myelinated fibres decreased more than large myelinated fibres, while in the sensorimotor type of SMON, the change was the reverse. Nuclear population remained unchanged in these diseases.

In spinocerebellar degeneration there was a close correlation between the decrease in myelinated fibres and the clinical findings such as sensory disturbance and diminished tendon reflexes, suggesting the presence of peripheral nerve involvement.

Myelinated fibres were reduced in cases of neurological diseases hitherto considered to be free of pathological changes in sensory nerves, including motor neurone disease, myopathy, tumours or vascular diseases of the brain and spinal cord. In motor neurone disease and myopathy the large fibres were decreased more than small fibres, and nuclear population was increased. In tumours or vascular disease of the central nervous system, the large and small fibres were decreased equally in number, and the nuclear population was within normal range.

Key words

Sural nerves Pathological changes Quantitative study 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adams, R. D., Denny-Brown, D., Pearson, C. M.: Diseases of muscle. A study in pathology. 2nd. ed. New York: Harper and Row 1962Google Scholar
  2. Blackwood, W., McMenemy, W. H., Meyer, A., Norman, R. M., Russel, D. S.: Greenfield's neuropathology. London: Edw. Arnold 1969Google Scholar
  3. Brain, W. R., Walton, J. N.: Diseases of the nervous system. London: Oxford 1969Google Scholar
  4. Brown, J. R.: Degenerative cerebellar ataxia. Neurology (Minneap.)9, 799–805 (1959)Google Scholar
  5. Calmant, H.: In: Henke und Lubarsch's Handbuch der speziellen pathologischen Anatomie und Histologie, Vol. 13 (ii), p. 2639. Berlin-Göttingen-Heidelberg: Springer 1958Google Scholar
  6. Causey, G., Barton, A. A.: The cellular content of the endoneurium of peripheral nerve. Brain82, 594–598 (1959)Google Scholar
  7. Chhuttani, P. N., Chawla, L. S., Chugh, F. S., Singh, H.: Landry-Guillain-Garré syndrome in India. J. neurol. Sci.7, 581–592 (1968)Google Scholar
  8. Chopra, J. S., Hurwitz, L. J.: Internodal length of sural nerve fibers in chronic occlusive vascular disease. J. Neurol. Neurosurg. Psychiat.30, 207–214 (1967)Google Scholar
  9. Dyck, P. J., Gutrecht, J. A., Bastron, J. A., Karnes, W. E., Dale, A. J. D.: Histologic and teased-fiber measurements of sural nerve in disorders of lower motor and primary sensory neurons. Proc. Mayo Clin.43, 81–123 (1968)Google Scholar
  10. Fincham, R. W., Van Allen, M. W.: Sensory nerve conduction in amyotrophic lateral sclerosis. Neurology (Minneap.)14, 31–33 (1968)Google Scholar
  11. Finean, J. B., Woolf, A. L.: An electron microscope study of degenerative changes in human cutaneous nerve. J. Neuropath. exp. Neurol.21, 105–115 (1961)Google Scholar
  12. Friedreich, N.: Über degenerative Atrophie der spinalen Hinterstrange. Virchows Arch. path. Anat.26, 391–419, 433–459;27, 1–26 (1863)Google Scholar
  13. Gairns, F. F., Garven, H. S. D., Smith, G.: The digital nerves and the nerve endings in progressive vascular disease of leg. Scot. med. J.5, 382–391 (1960)Google Scholar
  14. Haymaker, W., Kernohan, J. W.: The Landry-Guillain-Barré syndrome. A clinicopathologic report of fifty fatal cases and a critique of the literature. Medicine (Baltimore)28, 59–141 (1949)Google Scholar
  15. Hughes, J. T.: The peripheral sensory pathway in Friedreich's ataxia. Brain91, 803–817 (1968)Google Scholar
  16. Kinney, T. D., Maher, M. M.: Dermatomyositis. A study of five cases. Amer. J. Path.16, 561–594 (1940)Google Scholar
  17. Krücke, W.: Erkrankungen der peripheren Nerven. In: Handbuch der speziellen pathologischen Anatomie und Histologie. Bd. 5. Berlin-Göttingen-Heidelberg: Springer 1955Google Scholar
  18. McEntee, W. J., Mancall, E. L.: Neuromyositis. A reappraisal. Neurology (Minneap.)15, 69–75 (1965)Google Scholar
  19. Mott, F. W.: Case of Friedreich's disease with autopsy and systematic microscopical examination if the nervous system. Arch. Neurol. Psychiat. (Chic.)3, 180–200 (1907)Google Scholar
  20. Nakae, K., Yamamoto, S., Igata, A.: Subacute myelo-optico-neuropathy in Japan. Lancet1971 II, 510–512Google Scholar
  21. Namba, T., Scjman, M. H., Grob, D.: Conduction velocity in the ulnar nerve in hemiplegic patients. J. neurol. Sci.12, 177–186 (1971)Google Scholar
  22. Nichols, P. C., Dyck, P. J., Miller, D. R.: Experimental hypertrophic neuropathy: Change in fascicular area and fiber spectrum after acute crush injury. Proc. Mayo Clin.43, 297–305 (1968)Google Scholar
  23. Ochoa, J., Mair, W. G. P.: The normal sural nerve in man. I. Ultrastructure and number of fibers and cells. Acta neuropath. (Berl.)13, 197–216 (1969)Google Scholar
  24. Ohta, M.: Ultrastructure of sural nerves in myeloneuropathy associated with abdominal symptoms. Clin. Neurol.10, 487–500 (1970)Google Scholar
  25. Panin, N., Paul, B. J., Policoff, L. D., Eson, M. E.: Nerve conduction velocities in hemiplegia. Arch. phys. Med.48, 606–610 (1967)Google Scholar
  26. Penfield, W. G.: Alterations of the Golgi apparatus in nerve cells. Brain43, 290–305 (1920)Google Scholar
  27. Poole, E. W.: Ischemic and post-ischemic parethesiae in motor neurone disease. J. Neurol. Neurosurg. Psychiat.20, 225–227 (1957)Google Scholar
  28. Shahani, B., Russell, W. R.: Motor neuron disease. An abnormality of nerve metabolism. J. Neurol. Neurosurg. Psychiat.32, 1–5 (1969)Google Scholar
  29. Shimada, Y., Tsuji, T.: Halogenated oxyquinoline derivatives and neurological syndromes. Lancet1971 II, 41–42Google Scholar
  30. Thomas, G. A.: Quantitative histology of Wallerian degeneration. II. Nuclear population in two nerves of different fiber spectrum. J. Anat. (Lond.)82, 135–145 (1948)Google Scholar
  31. Thomas, P. K.: The connective tissue of peripheral nerve: an electron microscope study. J. Anat. (Lond.)97, 35–44 (1963)Google Scholar
  32. Thomas, P. K., Fullerton, P. M.: Nerve fiber size in the carpal tunnel syndrome. J. Neurol. Neurosurg. Psychiat.26, 520–527 (1963)Google Scholar
  33. Takahashi, K.: A clinicopathologic study on the peripheral nervous system of the aged. III. With special reference to the spinal nerve roots. Clin. Neurol.4, 151–160 (1964)Google Scholar
  34. Takahashi, K., Toyokura, Y.: An autopsied case of dermato-neuromyositis with severe lesion in the peripheral nervous system. Clin. Neurol.8, 693–698 (1968)Google Scholar
  35. Tohgi, H.: Quantitative studies on the biopsied sural nerve-With reference to experimental neuropathy. Jap. J. Med.12, 108–111 (1973)Google Scholar
  36. Tohgi, H., Tsukagoshi, H., Toyokura, Y.: Quantitative changes with age in normal shral nerves Acta neuropath. (Berl.) to appear (1977)Google Scholar
  37. Tsubaki, T., Honma, Y., Hoshi, M.: Neurological syndrome associated with clinoquinol. Lancet1971 I, 696–697Google Scholar
  38. Tsubaki, T., Toyokura, Y., Tsukagoshi, H.: Subacute myelo-optico-neuropathy following abdominal symptoms. A clinical and pathological study. J. Jap. Soc. int. Med.53, 779–790 (1964)Google Scholar
  39. Tsukagoshi, H., Tohgi, H., Toyokura, Y.: The peripheral nerve in cases of SMON. I. Histological study of sural nerve. Clin. Neurol.11, 392–399 (1971)Google Scholar
  40. Tsukagoshi, H., Tohgi, H., Toyokura, Y.: The peripheral nerve in cases of SMON. II. Clinicopathological study of sural nerve. Clin. Neurol.11, 400–405 (1971)Google Scholar
  41. Shiraki, H., Oda, M.: Neuropathology of subacute myelo-opticoneuropathy, SMON. Saishin Igaku24, 2479–2509 (1969)Google Scholar
  42. Wechsler, I. S., Brock, S., Weil, A.: Amyotrophic lateral sclerosis with objective and subjective (neuritic) sensory disturbances. A clinical and pathologic report. Arch. Neurol. Psychiat. (Chic.)21, 299–310 (1929)Google Scholar

Copyright information

© Springer-Verlag 1977

Authors and Affiliations

  • Hideo Tohgi
    • 1
  • Hiroshi Tsukagoshi
    • 1
  • Yasuo Toyokura
    • 1
  1. 1.Department of Neurology, Institute of Brain Research, Faculty of MedicineUniversity of TokyoTokyoJapan

Personalised recommendations