Elsevier

Human Pathology

Volume 23, Issue 10, October 1992, Pages 1106-1114
Human Pathology

Original contribution
Neuropathology of the spinal cord in the acquired immunodeficiency syndrome

https://doi.org/10.1016/0046-8177(92)90028-2Get rights and content

Abstract

The neuropathologic findings in the spinal cord were reviewed in 138 consecutive autopsies of patients with the acquired immunodeficiency syndrome. In all cases both the brain and spinal cord were examined by conventional histologic techniques, and in 63 cases immunohistochemistry was used to detect human immunodeficiency virus (HIV), Toxoplasma gondii, cytomegalovirus, and JC papovavirus antigens. The most common observation was a normal spinal cord (60%). Vacuolar myelopathy (VM) was observed in 23 (17%) cases. Human immunodeficiency virus myelitis was evident in 8% of cases. Human immunodeficiency virus myelitis was associated with HIV encephalitis in 65% of the cases. Opportunistic infections of the spinal cord were uncommon, consisting of cryptococcosis (five cases), cytomegalovirus (four cases), toxoplasmosis (one case), and progressive multifocal leukoencephalopathy (one case), and almost always were seen with cerebral and/or systemic infection by these agents. Malignant lymphoma rarely involved the spinal cord (four cases); all were B-cell lymphomas and were associated with cerebral and/or systemic lymphoma. Other abnormalities rarely observed were Wallerian degeneration of the corticospinal tracts or posterior columns (6%) and focal microinfarcts. Most cases of VM (78%) were not associated with HIV myelitis, and in the five patients with both VM and HIV myelitis, HIV-infected cells were not found in the regions affected by VM. In contrast, 65% of cases with VM were associated with HIV encephalitis. The pathogenesis of VM remains unknown; it is probably not due to direct infection by HIV.

References (45)

  • L Goldstick et al.

    Spinal cord degeneration in AIDS

    Neurology

    (1985)
  • CK Petito et al.

    Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome

    N Engl J Med

    (1985)
  • KH Anders et al.

    The neuropathology of AIDS: UCLA experience and review

    Am J Pathol

    (1986)
  • BA Navia et al.

    The AIDS dementia complex. II: Neuropathology

    Ann Neurol

    (1986)
  • CK Petito et al.

    Neuropathology of acquired immunodeficiency syndrome (AIDS): An autopsy review

    J Neuropathol Exp Neurol

    (1986)
  • BM Singh et al.

    Spinal cord syndromes in the acquired immune deficiency syndrome

    Acta Neurol Scand

    (1986)
  • SM de la Monte et al.

    Subacute encephalomyelitis of AIDS and its relation to HTLV-III infection

    Neurology

    (1987)
  • DW Dickson et al.

    Spinal cord pathology in pediatric acquired immunodeficiency syndrome

    Neurology

    (1989)
  • DJ Eilbott et al.

    Human immunodeficiency virus type 1 in spinal cords of acquired immunodeficiency syndrome patients with myelopathy: Expression and replication in macrophages

  • MR Grafe et al.

    Spinal cord and peripheral nerve pathology in AIDS: The roles of cytomegalovirus and human immunodeficiency virus

    Ann Neurol

    (1989)
  • W Lang et al.

    Neuropathology of the acquired immune deficiency syndrome (AIDS): A report of 135 consecutive autopsy cases from Switzerland

    Acta Neuropathol

    (1989)
  • H Maier et al.

    Vacuolar myelopathy with multinucleated giant cells in the acquired immune deficiency syndrome (AIDS). Light and electron microscopic distribution of human immunodeficiency virus (HIV) antigens

    Acta Neuropathol

    (1989)
  • Cited by (0)

    View full text