The prevalence of alcoholic cerebellar atrophy. A morphometric and histological study of an autopsy material.

The Purkinje cell densities in the cerebellar vermis were determined in 31 male alcoholics and 34 non-alcoholic controls under 70 years of age. In addition, all cases were examined histologically for atrophy of the superior vermis. All analyses were performed independently of each other and on randomized slides. The alcoholics had significantly lower Purkinje cell densities than the controls in the superior and middle segments of the vermis. Histologically verified atrophy of the superior vermis was found in 13 of the alcoholics (42%) and in 3 of the controls (9%). There was a good accordance between the morphometric data and the histologic diagnoses. The cause of the cerebellar atrophy in the 3 control cases is uncertain. It could be due to hidden alcoholism or to premature ageing. In a series of non-alcoholic control cases above 70 years, one third of the cases showed atrophy of the superior vermis similar to that of alcoholics. The diagnosis alcoholic cerebellar atrophy should therefore be made with great caution in cases over 70 years. From previous morphometric data on symptomatic cases (Victor et al. 1959), it can be assumed that the majority of the present cases with histologically verified atrophy had overt clinical symptoms. It is concluded that almost one half of all severe alcoholics have atrophy of the superior vermis which can be recognized morphologically and probably also clinically.