[Loss of catecholaminergic neuron in the hypothalamus of multiple system atrophy]

Autonomic failure is one of the primary clinical features of multiple system atrophy (MSA); while the hypothalamus is thought to be a higher center regulating the autonomic nervous system. In the hypothalamus, catecholamine depletion had been confirmed by neurochemical studies but no marked changes had yet been demonstrated by pathological studies. Using three MSA and three control cases, we evaluated the quantitative changes of catecholamine (CA)-containing neurons in the hypothalamus. As markers of CA neurons, neuromelanin (NM)- and tyrosin hydroxylase (TH)-containing neurons were stained by Fontana-Masson and the immunohistochemical technique alternatively. Serial coronal sections, 10 microns thick, were evaluated every tenth section for NM neurons, while two sections were evaluated for TH neurons. The distributions of NM and TH neurons were almost identical; most of them were clustered in the periventricular and arcuate nuclei. The mean numbers of NM and TH neurons per slice were significantly lower in MSAs than in the controls (T test, p less than 0.01); the former were 21.0, 31.6, and 13.7 in MSAs and 78.4, 54.1, and 84.3 in the controls, while the latter were 1.5, 15.5, and 20.5 in MSAs and 48.0, 62.0, and 50.5 in the controls. The clinico-pathological correlation was suggested by the significant differences in the number of TH neurons between two MSA cases: a case with severe orthostatic hypotension and a case with a milder one. The ratio of TH and NM neurons, as obtained from the adjusted sections, was constant in all MSA cases, and there was a positive statistical correlation, but it altered in each control case.(ABSTRACT TRUNCATED AT 250 WORDS)