The physiological functions of the medullary arcuate nucleus are supposed to be involved in autonomic cardioventilatory regulation, but neuropathological studies on neurodegenerative diseases have rarely reported about the arcuate nucleus. We quantitatively examined the neuronal density of the arcuate nucleus in patients with multiple system atrophy (MSA, n = 3), Parkinson's disease (PD, n = 3), amyotrophic lateral sclerosis (ALS, n = 2), and control subjects (n = 6), and statistically compared the findings in each group. Although the neuronal densities in PD and ALS patients were not different from that in the controls, MSA patients showed a marked depletion of neurons in the arcuate nucleus. The neuronal density (/mm2, mean +/- SEM) in the arcuate nucleus was 9.27 +/- 10.4 in MSA, and was significantly decreased (P < 0.05; Wilcoxon test), compared with that in control subjects (87.1 +/- 12.2). These results suggest that the lesioned arcuate nucleus is related to the pathogenesis of dysatonomia in MSA.