Morphometric study of cervical anterior horn cells and pyramidal tracts in medulla oblongata and the spinal cord in patients with cerebrovascular diseases

Abstract

To clarify the effect of damage to the upper motor neurons on lower motor neurons, quantitative studies were made regarding the cross-sectional area and the number of the individual anterior horn cells in the lateral nuclear cell groups of the 5th segment of the cervical spinal cord (C5), and regarding the cross-sectional areas of the pyramidal tract in the medulla, and in the spinal cord at the C5 and L2 levels. The subjects included 45 patients with cerebrovascular disease (CVD), and 50 age-matched controls without neurological disease. The medullary pyramid (MP) and the ventral funiculus (VF), ipsilateral to the hemispheric lesion, were compared with the MP and VF of the other, unaffected, side. The ventrol-lateral funiculus (VLF), anterior horn (AH) and C5 anterior horn cell (AHC), contralateral to the lesion, were also compared with the VLF, AH, and AHC of the other, unaffected, side. The AHC area (mean cross-sectional area of anterior horn cells) and the MP area, VF area, VLF area, AH area (mean cross-sectional areas of MP, VF, VLF and AH) associated with the hemispheric lesional side were significantly decreased, compared with those of the unaffected sides and the controls. However, there was no significant difference in AHC number between the affected and unaffected sides in patients with CVD, nor between the affected side and the controls. In order to examine the relationship between a decrease in AHC area and degree of paralysis, CVD patients were divided into two groups according to degree of muscle strength: the severe and mild paralysis groups. The MP area of the lesional side and AHC area of the clinically affected side in the severe paralysis group significantly decreased in size, compared with the corresponding areas in the mild paralysis group. Therefore, the degree of degeneration of the pyramidal tract and the degree of muscle paralysis, seemed to parallel the decrease of AHC area. These results suggest that both the damage in the pyramidal tract and the intensity of muscle paralysis (disuse atrophy) may have adverse effects on the AHC in hemiplegic or hemiparetic patients with CVD.