Lewy Body Count of McKeith et al from the 1996 Consensus Guidelines

 

Sections examined:

(1) brainstem

(2) anterior cingulate (limbic): rostral to the anterior commissure, about 1.5 cm caudal to the anterior pole of the genu

(3) transentorhinal (limbic): sulcal margin (collateral sulcus) of the parahippocampal gyrus in the plane of the red nucleus

(4) frontal (neocortical): middle frontal gyrus in the superior frontal sulcus at the plane just rostral to the temporal tip

(5) temporal (neocortical): superior sulcal margin (superior temporal sulcus) of the middle temporal gyrus at the plane of the amygdaloid and mammillary body

(6) parietal (neocortical): superior sulcal margin (intraparietal sulcus) of the parietal lobe at the plane 1 cm caudal to the posterior pole of the splenium

 

The tissue blocks should be taken perpendicularly, avoiding tangential cuts.

 

Staining: immunostaining with antibodies to ubiquitin with or without immunostaining with anti-tau (to exclude globose neurofibrillary tangles)

Number of Lewy Bodies per Section	Points
0	0
1 to 5	1
6 or more	2

 

total nonbrainstem score =

= SUM(points for sections 2 to 6)

 

Categories:

(1) brainstem predominant

(2) limbic (transitional)

(3) neocortical (diffuse)

 

Count	Brainstem Predominant	Limbic	Neocortical
cingulate	0 or 1	1 to 2	2
transentorhinal	0 or 1	1 to 2	2
frontal	0	0 or 1	1 to 2
temporal	0	1	1 to 2
parietal	0	0	1 to 2
total nonbrainstem	0 to 2	3 to 6	7 to 10