Clinical History
This 15-year-old patient presented with complaints of progressive muscle weakness. Muscle biopsy was performed. A few small intramuscular nerve twigs were present in the biopsy tissue.
What normal structure is demonstrated in the two provided electron microscopic images?
Answer:
The images show a normal neuromuscular junction.
Note the folded post-synaptic membrane of the skeletal muscle fiber, and synaptic vesicles in the pre-synaptic motor nerve terminal boutons (latter best seen in the high magnification image).
References/Additional Readings:
- https://en.wikipedia.org/wiki/Neuromuscular_junction
- Rodríguez Cruz PM, Cossins J, Beeson D, Vincent A. The Neuromuscular Junction in Health and Disease: Molecular Mechanisms Governing Synaptic Formation and Homeostasis. Front Mol Neurosci. 2020 Dec 3;13:610964. doi: 10.3389/fnmol.2020.610964. PMID: 33343299; PMCID: PMC7744297.
- Engel AG. The neuromuscular junction. Handb Clin Neurol. 2008;91:103-48. doi: 10.1016/S0072-9752(07)01503-5. PMID: 18631841.
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