Scinticisternography in presenile and senile degenerative disease

Comparative immunohistochemical characteristics of human choroid plexus in vascular and Alzheimer's dementia

Autoimmune alterations are indirectly supported in Alzheimer's disease by the demonstration of circulating antibodies directed to the epithelial basement membrane (BM) of the choroid plexus. We used immunohistochemical methods to compare the characteristics of choroid plexuses obtained postmortem from 15 patients. Six had a diagnosis of Alzheimer's disease, five had multi-infarct dementia (MID), and one suffered from mixed dementia. Similar tissue from three age-matched, non-demented controls was studied as well. Age-related psammoma bodies, lipofucsin, and flattened epithelial cells were present in all cases. Specific alterations were evident in Alzheimer's disease patients only. These were comprised of pseudolinear deposits of immunoglobulin (Ig)G and coarse deposits of C1q along the thickened and segmented epithelial BM, and were associated with IgM in five cases. Although no lymphoid infiltration was demonstrated, MHC Class II+ macrophages were observed in the plexus stroma, and numerous epithelial cells were class II+. These observations suggest that immune alterations, possibly of autoimmune origin, may be involved in Alzheimer's disease, leading to severe lesions of the choroid plexus. Such anomalies could be responsible for some of the alterations of cerebrospinal fluid (CSF) production or composition noted in this disease.

Antibodies to choroid plexus in senile dementia of Alzheimer's type

AIMS

To investigate whether autoantibodies to choroid plexus are present in human senile dementia.

METHODS

Serum samples from 40 elderly people presenting with characteristic, diagnostic criteria of senile dementia of Alzheimer's type and 20 age matched healthy controls were tested by indirect immunofluorescence for the presence of autoantibodies to choroid plexuses, using frozen sections of rat or human fetal brain tissue.

RESULTS

Significant labelling of choroid plexus basement membrane was observed in 17 of the 40 samples from patients with senile dementia; in the control series one sample of rat but not human plexus labelled positively (p < 0.01).

CONCLUSIONS

The antibodies identified in this series of patients with Alzheimer's disease suggest that autoimmune mechanisms might be responsible for some of the changes in cerebrospinal fluid production described in this disorder.

Delayed intracerebral hemorrhage after CSF shunt for communicating "normal-pressure" hydrocephalus. Case report

A patient with arterial hypertension and a history of cerebrovascular accidents presented with communicating normal-pressure hydrocephalus. Two weeks after ventriculo-peritoneal CSF shunt he had a fatal intracerebral hemorrhage. Delayed intracerebral hemorrhage is an extremely rare complication of ventricular CSF shunting, the possible mechanisms of which are briefly discussed.