Fig. 2.

Neuropathological findings. a–d Upper pons, and e–h paravertebral sympathetic ganglion. a Transverse section at the level of the upper pons, showing severe degeneration of transverse fibers in the basis pontis. Of note, the superior cerebellar peduncles (∗) are well-preserved in volume. KB myelin staining. Bar = 2 mm. b α-synuclein immunohistochemistry showing appearance of numerous GCIs in the pyramidal pathways in the area indicated by arrow in a. Bar = 20 μm. c This photo shows the rectangular area in a stained by α-synuclein immunohistochemistry. Loss of neurons of the locus ceruleus is evident. (∗): fourth ventricle. SCP: superior cerebellar peduncle. Bar = 200 μm. d Enlarged photo of the area in the rectangle of (c) showing Lewy bodies (long arrows) and a probable NCI (short arrow). Several GCIs are also seen (arrowheads). Bar = 50 μm. e, h Serial sections of the paravertebral sympathetic ganglia stained with H&E. e and α-synuclein immunohistochemistry (f), showing numerous swollen, Lewy body-like eosinophilic cell processes, which are synuclein immunoreactive (arrows). One of them (arrowhead) only shows weak marginal immunoreactivity. Bar = 20 μm. g 2 α-synuclein positive intracytoplasmic inclusions with a spiky appearance are seen in a sympathetic ganglion neuron. h This photo illustrates a ganglion neuron surrounded by swollen, α-synuclein positive presynaptic terminals. e Bar = 20 μm. f–h Bar = 20 μm. GCI, glial cytoplasmic inclusion; NCI, neuronal cytoplasmic inclusion; H&E, hematoxylin and eosin; KB, Klüver-Barrera.