Hemiplegic atrophy. Morphological findings in the anterior tibial muscle of patients with cerebral vascular accidents.

Anterior tibial muscle biopsies of the hemiplegic side of 16 patients with a cerebrovascular accident in the middle cerebral artery region were analyzed qualitatively and quantitatively by enzyme histochemistry and electron microscopy. Patients grouped according to the time lapsed as from the occurrence of the accident (1-17 months) demonstrated a progressive decrease in the fiber diameter and changes in fiber type distribution with predominant type II atrophy and type I predominance. Nuclear internalization, myopathic alterations, and perifascicular fatty infiltrations were observed constantly. In the affected fibers the ultrastructural findings were myofibrillar alterations with the formation of rods and cytoplasmic bodies. There was accumulation of lipofuscin, glycogen, and lipid droplets. Microvascular changes were observed frequently. Biopsies from the asymptomatic legs were either normal or showed age-related muscle alterations. Correlation was noted between the clinical and functional status of the patients and the morphological aspects seen in muscle biopsies.