       Document 0437
 DOCN  M9630437
 TI    AIDS-associated vacuolar myelopathy. A morphometric study.
 DT    9603
 AU    Tan SV; Guiloff RJ; Scaravilli F; Regional Neurosciences Centre, Charing
       Cross Hospital, London,; UK.
 SO    Brain. 1995 Oct;118 ( Pt 5):1247-61. Unique Identifier : AIDSLINE
       MED/96080055
 AB    The post-mortem pathology in 20 spinal cords of human immunodeficiency
       virus (HIV) infected patients with vacuolar myelopathy was quantified by
       evaluating (i) the intensity of myelin change, vacuolation and
       macrophage density; and (ii) the areas of white matter covered by each
       feature. Severity scores were constructed for (i) the anterior, lateral,
       and posterior white matter columns; (ii) each level of spinal cord; and
       (iii) the whole spinal cord [Cord Total and Cord Average Severity Scores
       (CTSS, CASS)]. Astroglial activation was scored separately. In 14 cords
       with mild-moderate vacuolar myelopathy (CASS = 23-259), macrophages were
       the most prominent pathological feature, and level severity scores were
       higher at mid-thoracic than cervical levels (P = 0.009). In six cords
       with severe vacuolar myelopathy (CASS = 396-614), vacuolation,
       demyelination and macrophages were equally evident and thoracic and
       cervical level severity scores were similar. The most severe lesions
       showed evidence of clearing of macrophages from the collapsed centres. A
       clinical lower limb score correlated with the anterior (P = 0.03) and
       lateral (P = 0.04) column total scores and with the CTSS (P = 0.04) in
       the nine patients who had had both myelopathy related disability and all
       cord levels available. There was no significant longitudinal gradient in
       score severity in the posterior, lateral or anterior columns and no
       evidence of a dying-back phenomenon. There was no evidence of Wallerian
       degeneration occurring as a primary process. Astroglial activation did
       not correlate with the severity or duration of the vacuolar myelopathy.
       Detection of HIV p24 antigen in the spinal cord related to the local
       presence of multinucleated giant cells and to antigen expression in the
       brain but not with the severity of vacuolar myelopathy. The pathology in
       vacuolar myelopathy appeared to start in the mid-low thoracic cord, with
       increasing rostral involvement as the disease became more severe. The
       relative prominence of macrophages in mild-moderate lesions suggests
       they may be involved early in the pathogenesis of vacuolar myelopathy.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY  Adult
       Astrocytes/PATHOLOGY  Brain/PATHOLOGY  Human  Immunohistochemistry  In
       Situ Hybridization  Macrophages/PATHOLOGY  Male  Middle Age  Myelin
       Sheath/*PATHOLOGY/ULTRASTRUCTURE  Spinal Cord
       Diseases/*COMPLICATIONS/VIROLOGY  Support, Non-U.S. Gov't
       Vacuoles/PHYSIOLOGY  Wallerian Degeneration/PHYSIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

