Occurrence of lymphocytes in the cortical neuropil in a case of Creutzfeldt-Jakob disease

Summary A 51-year-old woman suffering from visual disturbances, ataxia, spasticity, myoclonic jerks, and mental disturbances died completely demented after a 4-month course of the disease. The EEG showed typical diffuse triphasic sharp and slow-wave complexes. Histopathologic studies displaying spongiform changes in the gray matter, neuronal loss, and atrogliosis confirmed the clinical diagnosis of Creutzfeldt-Jakob disease. Electron-microscopic investigations revealed the occurrence of lymphocytes in the cortical neuropil.     

Ultrastructural neuropathology of chronic wasting disease in captive mule deer

Summary Chronic wasting disease (CWD), a progressive and uniformly fatal neurological disorder, is characterized neuropathologically by intraneuronal vacuolation, spongiform change of the neuropil and astrocytic hyperplasia and hypertrophy. Ultrastructural neuropathological findings consist of (1) extensive vacuolation in neuronal processes, within myelin sheaths, formed by splitting at the major dense lines or within axons; (2) dystrophic neurites (dendrites, axonal preterminals and myelinated axons containing degenerating mitochondria and pleomorphic, electron-dense inclusion bodies); (3) prominent astrocytic gliosis; (4) amyloid plaques; and (5) giant neuronal autophagic vacuoles. Other findings include activated macrophages and occasional spheroidal structures containing densely packed fibrillar material of unknown origin, abundant structures suggestive of degenerating microtubules entrapped in filamentous masses, vacuoles and myelin figures. Similar findings have been previously observed in scrapie-infected hamsters and Creutzfeldt-Jakob disease (CJD)-infected mice, bovine spongiform encephalopathy, and CJD indicating that CWD in captive mule deer belongs to the subacute spongiform encephalopathies (transmissible brain amyloidoses).     

An ultrastructural study of the cerebrospinal fluid in visna

Summary An electron microscopic examination was done on 8 samples of cerebrospinal fluid (CSF) from Icelandic sheep infected by the intracerebral route with visna virus. The specimens were collected 1 month, 2 months, and 4 years after infection. A differential cell count done on low-power electron micrographs showed that the cellular exudate was composed of mononuclear cells mainly macrophages and lymphocytes with a few plasma cells. Macrophages were with one exception more numerous than lymphocytes and an increased proportion of macrophages showed evidence of phagocytosis with time after infection. Reactive lymphocytes were in general more numerous than small lymphocytes. Various stages in the maturation of plasma cells were observed. The cellular composition in the CSF is compatible with the view that visna is an immunopathological process.Myelin figures and fragments of myelinated axons were observed in two specimens indicating an active myelin-breakdown. The possibility that escape of myelin into the CSF may lead to sensitization to myelin antigens and perpetuation of this chronic neurologic affection is discussed.Visna virions could not be demonstrated.     

Further observation of Japanese Creutzfeldt-Jacob disease with widespread amyloid plaques

Summary An autopsy case of Creutzfeld-Jacob disease with widespread amyloid plaques is reported. A 45-year-old Japanese man, whose father had died of a similar disease, had a 5-year illness characterized by progressive cerebellar signs. Mental changes and brain-stem signs developed in the late stage. Myoclonus frequently occurred. Akinetic mutism ensued. The autopsy revealed spongiform encephalopathy with widespread amyloid plaques and extensive degeneration of the white matter. This disease, Western Gerstmann-Sträussler-Scheinker disease and panencephalopathic type of Creutzfeld-Jacob disease are discussed.     

Relationship of microglia and scrapie amyloid-immunoreactive plaques in kuru,Creutzfeldt-Jakob disease and Gerstmann-Sträußler syndrome

Kuru, Creutzfeldt-Jakob disease (CJD) and Gerstmann-Sträussler syndrome (GSS) are transmissible dementias affecting humans characterized neuropathologically by intraneuronal vacuolation, spongiform change, astrocytic hypertrophy and hyperplasia and the variable presence of amyloid plaques. It has been suggested that microglia are amyloid-forming cells, which play an essential role in amyloid plaque formation. To study the relationship between microglia and amyloid plaques in kuru, CJD and GSS, cerebellar tissues were examined by the double-immunostaining technique using anti-ferritin antibodies as the microglial marker and anti-scrapie amyloid antibody as plaque marker. Ferritin-immunoreactive microglia were observed interdigitating with and among unicentric, multicentric and diffuse types of scrapie amyloid-immunoreactive plaques and were found to a lesser extent in the neuropil. In kuru and CJD, scrapie amyloid-immunoreactive plaques were predominantly unicentric and were observed in the granular layer. In kuru, 53% of the amyloid plaques were associated with microglia, whereas only 30% of plaques in CJD were. In contrast, scrapie-amyloid-immunoreactive plaques in GSS were of the multicentric type, predominantly observed in the molecular layer, and 90% of these plaques were associated with microglia. Our data indicate that microglia are frequently associated with scrapie amyloid-immunoreactive plaques in GSS, less commonly in kuru and to a much lesser extent in CJD, suggesting that microglia may play a variable but important role in the formation of plaques in the transmissible spongiform encephalopathies.D.C. Guiroy is supported by the Sonderforschungsbereich 194 from the Deutsche Forschungsgemeinschaft; P.P. Liberski is a recipient of a grant from the Kosciuszko Foundation while in USA and the intramural grant from the Medical Academy Lodz, while in Poland     

Gerstmann-Sträussler's disease,atypical multiple sclerosis and carcinomas in a family of sheepbreeders

Summary A new family with the Gerstmann-Sträussler type of subacute spongiform encephalopathy is described. Atactic symptoms, dysarthrias, and personality changes characterized the clinical course. The clinical pattern of a father and his two sons was very similar. They had been in contact with sheep by occupation. A rapidly progressing demyelinating disease (transitional diffuse-multiple sclerosis) occurred in the same family, as well as numerous cases of carcinoma. Morphologically, the Sträussler type can be differentiated from other subacute spongy encephalopathies by the occurrence of Kuru-Plaques and numerous multicentric floccular plaques both in the cerebral and cerebellar cortex, basal ganglia, and white matter.     

Alpers' disease — A variant of Creutzfeldt-Jakob disease and subacute spongiform encephalopathy?

Summary A case of Alpers' disease is described and the findings analysed in relation to subacute spongiform encephalopathy and Creutzfeldt-Jakob disease, suggest that these three diseases have enough in common to indicate that they represent the same reaction of the brain at different ages and are all possibly based on an anoxic or vascular pathogenesis.

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Zusammenfassung Ein Fall von Alpersscher Krankheit wird beschrieben und die Befunde in ihrer Beziehung zur subakuten spongiformen Encephalopathie und zur Jakob-Creutzfeldtschen Krankheit erörtert. Die Annahme wird vorgebracht, daß diese drei Krankheitsbilder durch einige Gemeinsamkeiten auf eine und dieselbe Reaktionsform des Gehirns, die mit dem Alter differiert, hinweisen und möglicherweise eine anoxische oder vasculäre Pathogenese besitzen.

     

Defining the limits of prion disease

The term prion disease applies to any disease in which there is an accumulation in brain of the abnormal isoform of prion protein, known as PrP^sc. These diseases include all the transmissible spongiform encephalopathies of humans and animals and their related atypical forms. Although there are clear clinical and neuropathological indicators in the majority of cases, the atypical forms present particular diagnostic difficulties because their clinical presentation may closely resemble much more common forms of dementia. On pathological examination the brain may show no spongiform encephalopathy, and attempts at transmission are often not successful in these cases. There are various biochemical and immunohistochemical ways in which prion disease can be detected. Some of these require the use of fresh/frozen tissue which is often not available unless prion disease is already suspected. Some previously unsuspected cases have been detected by genetic analysis of the PrP gene. This approach must be used with caution since there are several rare polymorphisms in the PrP gene which are not pathogenic and possession of a pathogenic mutation does not prevent the occurrence of more common neurological disorders at an earlier age, some of which may be treatable.     

Experimental transmission of human subacute spongiform encephalopathy to small rodents

Summary Further experimental transmission of Creutzfeldt-Jakob disease (CJD) from three patients to mice and rats was carried out successfully. The clinical signs and pathologic features of spongiform encephalopathy transmitted to animals were much the same as in previous experiments, except that distribution of the lesions in the mice differed with each inoculated material taken from the patients. These observations suggest the multiplicity of CJD agents, as in the case of scrapie agents.     

Deposition of the prion protein (PrP) during the evolution of experimental Creutzfeldt-Jakob disease

We studied the immunocytochemical distribution of the prion or proteinase-resistant protein (PrP) during the evolution of experimental Creutzfeldt-Jakob disease (CJD) in mice. Fifty-one brains were collected up to 22 weeks following intracerebral inoculation with the Fujisaki strain of the CJD agent. Slides were also immunostained for apolipoprotein E (apoE) and glial fibrillary acidic protein. Vacuolar changes with focal astrocytosis first occurred around the needle track at week 2 and later spread along white matter tracks. Until week 12, changes were asymmetrical, affecting more the side of inoculation. Spongiform change and astrogliosis spread subsequently to the gray matter. Time course and intensity of spongiform change and immunocytochemistry for PrP were discrepant: in most brain regions, severe vacuolation preceded immunocytochemically detectable PrP accumulation. PrP deposits in form of small dots were first detectable at week 6 in the area surrounding the needle track. After week 7, plaque-like amorphous PrP deposits were observed in white matter pathways. Finally, PrP was detectable also in basal ganglia and in the dorsal hippocampus (week 13) and in the neocortex (week 17), as the synaptic type of PrP immunopositivity. In the hippocampus, diffuse PrP deposits paralleled spongiform change, while in the cortex severe vacuolation was accompanied only by weak synaptic PrP deposits. Immunocytochemically detectable apoE was restricted to compact plaque-type PrP deposits after week 15. We conclude that disease-specific neuropathology spreads from the needle track along white matter pathways towards the gray matter; in this model, there is some discrepancy between development of tissue pathology and immunocytochemically detectable deposition of PrP. Immunocytochemically detectable apoE deposition follows PrP accumulation. Received: 22 December 1998 / Revised, accepted: 6 April 1999     

Anatomical study of experimental kuru in the rhesus monkey

Summary The authors report the morphology and topography of CNS lesions in experimental kuru (third passage) in the rhesus monkey. The main lesions encountered are spongiosis of the neuropile with neuronal vacuolization, moderate astrocytic gliosis, and slight neuronal depopulation. In all cases, lesions predominated in the grey matter of the cerebral hemispheres (cortex, neostriatum). Lesions were minimal in cerebellum and brain stem. The authors compare their results with these observed in human kuru and experimental kuru of other species of Primates (chimpanzee, spider monkey, marmoset, squirrel monkey).     

Fatal familial insomnia with an unusual prion protein deposition pattern: an autopsy report with an experimental transmission study

We recently performed a post-mortem examination on a Japanese patient who had a prion protein gene mutation responsible for fatal familial insomnia (FFI). The patient initially developed cerebellar ataxia, but finally demonstrated insomnia, hyperkinetic delirium, autonomic signs and myoclonus in the late stage of the illness. Histological examination revealed marked neuronal loss in the thalamus and inferior olivary nucleus; however, prion protein (PrP) deposition was not proved in these lesions by immunohistochemistry. Instead, PrP deposition and spongiform change were both conspicuous within the cerebral cortex, whereas particular PrP deposition was also observed within the cerebellar cortex. The abnormal protease-resistant PrP (PrP(res)) molecules in the cerebral cortex of this case revealed PrP(res) type 2 pattern and were compatible with those of FFI cases, but the transmission study demonstrated that a pathogen in this case was different from that in a case with classical FFI. By inoculation with homogenate made from the cerebral cortex, the disease was transmitted to mice, and neuropathological features that were distinguishable from those previously reported were noted. These findings indicate the possibility that a discrete pathogen was involved in the disease in this case. We suggest that not only the genotype of the PrP gene and some other as yet unknown genetic factors, but also the variation in pathogen strains might be responsible for the varying clinical and pathological features of this disease.     

Reactive microgIia in Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease (CJD) is characterized by a loss of neurons accoinpanied by astrogliosis and spongiform changes in the neuropil. It has been recognized that reactive inicroglia occur in CJD but little is known about the regional distribution and extent of the microglial activation. We have. therefore, examined six brains from cases of sporadic CJD by immunohistochemical labelling of grey and white matter microglia froin frontal, parietal. temporal. and occipital lobes, striatum, thalamus, cerebellum and brain stem with RCA-I, LCA. CD68. HIA-DR. and HAM56. Microglial activation occurred in the grey matter where astrogliosis and prion protein (PrP) deposits were prominent. Processes of activated microglia surrounded the outer rim of spongy vacuoles. A diffuse microglial response was seen in the white matter that was immunophenotypically different from grey matter. Double-labelling with microglial marlters and anti-PrP showed that activated inicroglia did not contain PrP-immunoreactivity. Therefore a primary role of microglia in PrP processing seem unlikely. Activated inicroglia may contribute to neuronal damage in CJD due to their cytotoxic potential.     

Immunocytochemical and ultrastructural studies of Werdnig-Hoffmann disease

Summary Neuronal alterations in two cases of Werdnig-Hoffmann disease (WH) were investigated immunocytochemically and ultrastructurally. Ballooned neurons (BNs) were found in anterior horn, Clarke's column, dorsal root ganglion and thalamus. Anti-phosphorylated neurofilament antibodies preferentially stained the peripheral perikarya and proximal neuronal processes of BNs, whereas anti-ubiquitin antibodies preferentially stained the central perikarya of BNs. Ultrastructurally, BNs showed degenerative changes ranging from a diffuse increase of neurofilaments to a centrally accentuated accumulation of mitochondria and vesicular or membranous profiles. Our studies suggest that ubiquitinated degradation products accumulate in the center of the BN's perikaryon and displace aberrantly phosphorylated neurofilaments to the periphery. BNs in WH probably reflect an intrinsic alteration in the metabolism of neurofilaments that is associated with regressive changes in the neuron and eventually neuronal death.Supported in part by USPHS grants NS24453, HD03110, and ES01704     

小儿moyamoya病颞浅动脉组织学和超微结构与免疫组化研究

报告了５例小儿ｍｏｙａｍｏｙａ病（ＭＤ）颞浅动脉（ＳＴＡ）的组织学和超微结构病理，它们的变化是中膜平滑肌细胞变性、破坏，内弹力板变薄、断裂和内膜平滑肌细胞增生。这些变化与成人ＭＤ脑动脉和ＳＴＡ的病变一致。小儿ＭＤ的ＳＴＡ中能看到大量较早期和较轻的病变，如中膜平滑肌细胞空泡变性、质膜破坏、或仅见于内弹力板两侧的肌细胞坏死；内弹力板破坏轻；内膜增生轻，没有管腔狭窄，与成人不同。本文对ＭＤ动脉病变的发展过程和病因问题提出了看法。     

Spongiform encephalopathy in a patient with acquired immune deficiency syndrome (AIDS)

Summary The histological and ultrastructural findings of subacute spongiform encephalopathy (SSE) are described in the cerebral cortex and basal ganglia of a homosexual patient who died with acquired immune deficiency syndrome (AIDS). It is suggested that SSE, beside the diffuse AIDS leukoencephalopathy, might be another morphological substrate of the AIDS dementia complex.Supported in part by a scholarship from the Alexander von Humboldt Foundation (FC-S)     

Tubulovesicular structures in Creutzfeldt-Jakob disease

Summary By electron microscopy tubulovesicular structures (TVS) have been consistently observed in brain tissue of transmissible spongiform encephalopathies such as natural and experimental scrapie, bovine spongiform encephalopathy and experimentally induced, but not naturally occurring, Creutzfeldt-Jakob disease (CJD). For the first time we report here the presence of TVS in human brains with CJD as detected by transmission electron microscopy. TVS were observed in all three CJD specimens (two biopsies, one autopsy), but they were rare and were found only in one or two location(s) per grid. TVS were seen in distended pre- and postsynaptic terminals and measured approximately 35 nm in diameter; they were smaller and of higher electron density than synaptic vesicles. Their occurrence in all types of transmissible spongiform encephalopathies irrespective of the affected host and the strain of the infectious agent suggests their biological significance.Supported by the Austrian Fund for the Advancement of Scientific Research (P8196-MED), and a grant from the Polish Academy of Science (VIII/40) (to P. P. L.)     

Neovasculature and blood-brain barrier in ischemic brain infarct

Summary In a 53-year-old man with a progressive mental deterioration and myoclonic jerks, brain biopsy failed to show any significant light microscopical findings. Electron microscopy revealed membranebound vacuolar inclusions in many neuronal nuclei as the only prominent finding. Hamsters intracerebrally inoculated with the biopsy material demonstrated typical spongiform changes in the gray structures of the brain when sacrificed on the 309th and 332nd days post inoculation, characteristic of experimental Creutzfeldt-Jakob disease (CJD). These intranuclear vacuolar inclusions, originally reported in experimental Creutzfeldt-Jakob disease in this laboratory, may be a valuable electron microscopic feature in some CJD cases and may play an important role in supporting the diagnosis of CJD.Supported in part by the NIH grants AG 03106 and NS 12674     

New ultrastructural changes of the ependyma in experimental hydrocephalus

Summary New ultrastructural alterations of the ependymal cells in the altered container model of experimental feline hydrocephalus are described. These include half desmosomes and a basal lamina on the apical surface of the ependymal cells, punctate adhesion-like structures between intraventricular mononuclear cell and the apical surface of the ependymal cells and unusual distortion of the ependymal cells. The significance of these previously unreported morphological alterations is unknown.Supported partially by a National Institute of Health Teacher/Investigator Development Award: NSI-EA 1 K07 00769-01 NSPH