A quantitative histological study of the cerebellar vermis in alcoholic patients.

A quantitative histological study was made of the cerebellar vermis in 10 male alcoholic and 8 age-matched control cases. The mean Purkinje cell loss was 21% in the alcoholic group. The small rostral and caudal lobes were most severely affected. The mean Purkinje cell density per unit length of foliae showed similar changes. Histological measurements of the area of the molecular, granular and medullary layers of the cerebellar vermis showed that the molecular layer varied in the degree of shrinkage between lobes (from 11 to 39%) while the granular layer showed a consistent shrinkage (9 to 10%). The molecular layer appears to be the most vulnerable region in chronic alcoholics. Brains taken from patients with Wernicke's encephalopathy had particularly low Purkinje cell counts and a large pericerebral space. Nutritional deficiency would seem to be an important factor in the causation of the observed neuropathology, with liver disease playing a lesser role. Evidence that repeated alcohol withdrawal can lead to further brain disturbances is reviewed.