Comparison of modified Bielschowsky silver impregnation and anti-ubiquitin immunostaining of cortical and nigral Lewy bodies.

We have compared the sensitivity of a modified Bielschowsky silver impregnation with that of anti-ubiquitin immunostaining for the detection of Lewy bodies in five cases of diffuse Lewy body disease. In two of the cases there were neuritic plaques and neurofibrillary tangles within the neocortex in sufficient numbers to warrant an additional diagnosis of Alzheimer's disease. The modified Bielschowsky technique was as effective as anti-ubiquitin immunohistochemistry at demonstrating cortical Lewy bodies in 7 micron-thick paraffin sections. As might therefore be expected, silver impregnation of 20 micron-thick sections revealed significantly more cortical Lewy bodies than did the immunostaining of 7 micron-thick sections (P = 0.004). The silver impregnation had the further advantage of allowing much better visualization of the Alzheimer-type changes. In contrast to the cortical-type Lewy bodies, the dense-core type present in sections of midbrain were relatively poorly impregnated by the modified Bielschowsky method, possibly reflecting differences in the composition of the two types of inclusion.