Neuroaxonal dystrophy in subacute dementia. Case report

Spinal neuroaxonal dystrophy and angioneuromatosis

A man of 75 years of age had had lightning pains in the legs for 8 years. Clinical examination demonstrated mild pyramidal signs and involvement of the posterior columns. A morphine pump was placed in the epidural space in the lumbar region to treat the pain. He died two weeks later from a massive pulmonary embolism. The nervous system was examined using the classical techniques along with the use of poly- and monoclonal antibodies against nervous system specific proteins. The following features were demonstrated: neuroaxonal dystrophy of the posterior and anterior horns, and the posterior columns and corticospinal pathways in decreasing order of importance; angioneuromatosis of the grey matter of the lumbosacral spinal cord and loss of neurons of the dorsal spinal root ganglia and bilateral degeneration of the fasciculus gracilis. Previously, we have only found such amounts of spheroids in the spinal cord as measured here in cases of Seitelberger's disease. The angioneuromatosis was isolated and did not result from previous trauma nor was it associated with a known phacomatosis. This combination of features is very unusual and may explain the clinical features including the lightning pains.

Pathologic axons and synapses in human neuropsychiatric disorders

Ultrastructural studies of cerebral biopsy specimens from patients with various forms of psychomotor retardation and dementia have disclosed pathologic changes in axons and presynaptic or postsynaptic processes. The clinical disorders with lesions in axons and presynaptic terminals are reviewed. Three basic abnormalities have been detected: proliferation of tubulovesicular structures which probably originate from the smooth endoplasmic reticulum, "abnormal" mitochondria, and proliferation of 80 to 100 A filaments. Understanding of the pathogenesis of human disorders associated with axonic or "synaptic" lesions will probably depend on progress in areas of basic biomedical research concerned with the synthesis and turnover of biological membranes and the packaging and secretion of neurotransmitters, elucidation of mechanisms of cytoplasmic streaming and axoplasmic flow, and biophysical and biochemical characteristics and functions of "fibrous" proteins (neurotubules, neurofilaments, pathologic fibrous proteins). In several cases of mental retardation of unknown etiology, abnormal dendritic spines of cortical neurons have been observed with the use of the Golgi method. These dendritic (postsynaptic) disorders have been attributed to defective development ("dysgenesis"). The knowledge provided by ultrastructural analysis of brain tissue from the human disorders of mental retardation or dementia is "still formless, incomplete, lacking the essential threads of connection," and only future developments in lacking neurobiology will make possible the dissection of the primary phenomena from the secretory and probably irrelevant findings.

Infantile neuroaxonal dystrophy (Seitelberger's disease). A light and ultrastructural study

The findings in a case of infantile neuroaxonal dystrophy are presented. Light microscopy shows wide distribution of spheroids, cerebullar atrophy and striatal degeneration. Electron microscopy shows numerous spheroids consisting of tubulo-vesiculo-membranous profiles. The dystrophic changes appear first in the axon seem to be modified by axostasis and/or transneuronal degeneration in addition to the dystrophic changes. The participation of the endoplasmic reticulum and microtubules in spheroid formation and their relation to the malformation of the synaptic vesicles have been discussed. Diverse mitochondrial abnormalities and Hiranolike body are also described.