Acute Demyelination, Neuropathological Diagnosis, and Clinical Evolution
| Autor: | Hugh Staunton, D. Annesley-Williams, Michael A. Farrell, Francesca Brett |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Pathology medicine.medical_specialty Multiple Sclerosis Biopsy Autopsy Neuropathology Plasma cell Pathology and Forensic Medicine Cellular and Molecular Neuroscience Neuroimaging medicine Humans Axon Lost to follow-up medicine.diagnostic_test business.industry Brain Astrocytoma General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging medicine.anatomical_structure Neurology Acute Disease Disease Progression Female Neurology (clinical) Tomography X-Ray Computed business Demyelinating Diseases |
| Zdroj: | Journal of Neuropathology & Experimental Neurology. 59:477-489 |
| ISSN: | 1554-6578 0022-3069 |
| DOI: | 10.1093/jnen/59.6.477 |
| Popis: | A retrospective analysis of 14 patients who presented with a progressively expanding mass lesion(s) shown at biopsy/autopsy to represent acute demyelination was carried out. The aims of this study were to determine the optimal neuropathological approach to diagnosis and to determine the clinical evolution of this condition. Subsequent investigations and clinical outcome studies confirmed MS in 10 cases. Two patients had received an incorrect neuropathologic diagnosis of astrocytoma resulting in cranial irradiation. Key histologic parameters in establishing a diagnosis of acute demyelination were a predominance of lipid filled macrophages, macrophage alignment along axons, and an absence of oligodendroglial inclusions. Axonal injury was present in all cases and a lymphocytic/plasma cell infiltrate was sparse in areas of demyelination. Neuroimaging revealed single lesions in 10 patients and multiple lesions in 4 patients. Two patients were lost to follow-up, 3 died within 18 months of diagnosis, 8 had a relapsing remitting clinical course, and 1 patient had a chronic progressive course. In conclusion, a dense lymphocytic and plasma cell infiltrate is unusual in acute human demyelination. Although axonal injury is a frequent histologic finding in acute demyelination, it does not preclude a favorable clinical outcome. |
| Databáze: | OpenAIRE |
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