Alexander's disease

This is the first pathologic report of an infant at 37 weeks' gestation with Alexander's disease. The findings demonstrate that the disease can arise in utero and be extensive at birth before myelination begins.

Adrenoleucodystrophy: neurophysiological aspects

Neurophysiological investigations (EEG, ERG, VEP) were carried out in 14 boys with adrenoleucodystrophy, and in two siblings with adrenocortical deficiency, but without neurological symptoms. Irregular large amplitude (200-800 microvolts) slow activity was found in the EEG of all adrenoleucodystrophy patients, usually more prominent over the posterior regions of the brain. No short duration spikes or complex wave were seen in any of the EEGs, even in those patients who had had seizures. Clinical deterioration was not always accompanied by an increase in EEG abnormalities. The ERG was of usual amplitude and wave form, while the VEP (flash) was altered in four cases. The two clinically unaffected siblings had normal ERG/VEP, and only a modest excess of slow waves in the EEG. The neurophysiological findings in adrenoleucodystrophy are not seen in other diseases with similar clinical symptoms in the same age group.

Kearns-Sayre syndrome. A case of the complete syndrome with encephalic leukodystrophy and calcification of basal ganglia

A case of a complete Kearns-Sayre syndrome, of early onset, associated with cerebral and cerebellar leukodystrophy and basal ganglia calcification is reported. The clinical, neurophysiological and morphological findings suggest multisystem involvement.

A fatal cause of sexual inadequacy in men: adreno-leukodystrophy

Diminished libido, impotence and infertility have been detected in 5 of 6 men with adreno-leukodystrophy, a universally fatal disease. The importance of the clinical recognition of these patients and their separation from others with relatively innocuous causes of testicular dysfunction are discussed.

[Adrenomyeloneuropathy in adults. Relationship with adrenoleukodystrophy in children (author's transl)]

The case reported concerns a man in whom appeared gradually, since the age of twenty-seven years, difficulty in walking and sexual impotence. The neurological syndrome consisted of pyramidal signs and objective sensory disorders of the lower limbs, intermittent sphincter disorders and mild mental deterioration, which was progressive. Biopsy of a sensory nerve showed rarefaction of myelinated fibres. The endocrine syndrome consisted of peripheral adrenal insufficiency, which was undoubted but with biologic evidence only. There was no response of plasma cortisol during five stimulation tests with tetracosactide and there was a gradual rise in plasma A.C.T.H. The clinical picture was thus that of an adrenomyeloneuropathy.

Addison disease and cerebral sclerosis in an apparently heterozygous girl: evidence for inactivation of the adrenoleukodystrophy locus

Cerebral sclerosis and Addison disease were observed at age 14 years in a previously healthy sister of an affected boy. Clinical findings and family history established the diagnosis of X-linked adrenoleukodystrophy, which is normallly confined to males. The affected female has a normal karyotype; both X chromosomes are morphologically inconspicuous. Thus, this patient may be the first documented example of clinically manifest adrenoleukodystrophy in a heterozygote, which supports our previous conclusion that this X-linked locus is subject to inactivation.

[Adrenoleukodystrophy (melanodermic leukodystrophy). Report of an anatomo-clinical case]

The case of a 14-year-old boy with "diffuse cerebral sclerosis", preceded by signs of primary adrenal cortical insufficiency for 7 years with familiar antecedents is reported. This disorder, named adrenoleukodystrophy, has a sex-lin(ed recessive inheritance. The clinical picture is characterized by mental deterioration, gait disturbances, visual impairment, associated with primary adrenal cortical insufficiency. Confirming the data from literature, in our case the pathological study showed myelin degeneration and diffuse gliosis in the cerebral white matter, with no involvement of subcortical fibers. Inflammatory cells are common, and have a perivascular distribution. In the fasciculata and reticular zones of the adrenal gland, "baloon-shaped" cells are evident, most of them presenting a vacuolized and striated cytoplasm. Similar lipidic inclusions have been found in the Schwann cells of the periheral nerves and testis. The findings are compared with twenty cases from the literature.

[Adrenoleukodystrophy (Schilder-Addison's disease): a probable case in an adult (author's transl)]

Adrenoleukodystrophy (Schilder-Addison's disease) is a sex-linked recessive syndrome usually observed in children, associating neurological disorders and Addison's disease. Its outcome is death after a few years. The authors report the case of a man in whom a spastic paraparesis and a mental deterioration appeared at the age of 30 years. A biological adrenal deficiency was found: plasma cortisol and urinary 17-hydroxy-steroids and 17-ketosteroids failed to increase after synacthen stimulation; plasma ACTH level was above normal. Since two nephews of the patient suffered from adrenoleukodystrophy, the same disease is likely in the reported patient.

[A contribution to the psychopathology of patients with open heart surgery (author's transl)]

The results of a larger study of psychopathological disorders in relation to pre-operative and post-operative examined heart surgery patients, where the heart-lung machine was used, will be shown, to begin with, on 20 patients. Pre-operative examination showed quite clearly, among other things, that patients suppress obvious operation risks. General mental disorders were seen post-operative in 4 patients, and these were diagnosed as organic psychosis. A comparison between psychotic and other patients shows, among other things, that somatic predictors such as cerebral sclerosis and atrophy, or a cerebral trauma tend to promote post-operative psychosis. A releasing cause could be a cerebral hypoxia brought about by the extracorporeal blood circulation. In our opinion psychological factors can only be found in the contents of psychosis.

Thrombotic thrombocytopenic purpura in a child with Alexander's disease

Thrombocytopenic purpura developed in a 14-year-old boy with Alexander's disease; he died. The proximity of Rosenthal fibers to small vessels in the brain, the presence of perivascular lymphocytes in the brain, and the presence of complement in renal arterioles suggest that the Rosenthal fibers could have injured the endothelium-basement membrane resulting in an immune response triggering the thrombotic thrombocytopenic purpura.

Skin and conjunctival biopsies in adrenoleukodystrophy

Conjunctival and skin biopsies were performed in an 11 1/2 year-old caucasian male affected by adrenoleukodystrophy (ALD). In Schwann cells surrounding myelinated axons in conjunctival and dermal nerve bundles, empty clefts and few arrays of lamellae were discovered. The vacuolization in the eccrine glands of the skin, another striking feature, has not been reported previously in ALD. The obtained results suggest that ALD can be diagnosed in skin specimens precluding major surgery for biopsy. They provide support to the hypothesis of Schaumburg et al. (1975) that ALD is a generalized metabolic disorder.