MULTIFOCAL NECROTIZING LEUKOENCEPHALOPATHY WITH PONTINE PREDILECTION IN IMMUNOSUPPRESSED PATIENTS - A CLINICOPATHOLOGICAL REVIEW OF 16 CASES

被引:37
作者
ANDERS, KH
BECKER, PS
HOLDEN, JK
SHARER, LR
CORNFORD, ME
HANSEN, LA
HAMILTON, R
VINTERS, HV
机构
[1] UNIV CALIF LOS ANGELES, MED CTR, DEPT PATHOL & LAB MED NEUROPATHOL, CHS 18-170, LOS ANGELES, CA 90024 USA
[2] UNIV CALIF LOS ANGELES, MED CTR, BRAIN RES INST, LOS ANGELES, CA USA
[3] KAISER PERMANENTE MED CTR, DEPT PATHOL, LOS ANGELES, CA USA
[4] JOHNS HOPKINS UNIV, SCH MED, DEPT PATHOL, BALTIMORE, MD 21205 USA
[5] ST PAULS HOSP, DEPT PATHOL, VANCOUVER V6Z 1Y6, BC, CANADA
[6] UNIV BRITISH COLUMBIA, VANCOUVER V6T 1W5, BC, CANADA
[7] UNIV MED & DENT NEW JERSEY, NEW JERSEY MED SCH, DEPT LAB MED & PATHOL, NEWARK, NJ 07103 USA
[8] UCSD, SCH MED, DEPT PATHOL NEUROPATHOL, LA JOLLA, CA USA
关键词
MULTIFOCAL NECROTIZING LEUKOENCEPHALOPATHY; IMMUNOSUPPRESSION; DEMYELINATION; PONS; ACQUIRED IMMUNODEFICIENCY SYNDROME; LEUKEMIA;
D O I
10.1016/0046-8177(93)90140-C
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Multifocal necrotizing leukoencephalopathy (MNL) is characterized by multiple, usually microscopic, foci of necrosis confined primarily to the white matter of the basis pontis, but sometimes found else-where in the central nervous system. All 16 patients in whom we identified MNL had underlying immunosuppression, either naturally occurring or iatrogenic, including the acquired immunodeficiency syndrome (seven patients), acute leukemias (four patients), and lymphoma (one patient). One patient each had severe combined immunodeficiency, orthotopic liver transplantation, Shwachman-Diamond syndrome, and idiopathic thrombocytopenic purpura treated with high-dose steroids. Histologically, lesions of MNL show demyelination, spongiosis, axonal swelling, minimal histiocytic infiltrates, and frequent axonal calcification. Multifocal necrotizing leukoencephalopathy lesions were found in the pons of all patients, most commonly in the crossing pontocerebellar fibers, but often in the descending white matter tracts and rarely in the tegmentum. Three cases also showed nonpontine foci of MNL involving the white matter of the medulla, cerebellum, and cerebral hemispheres. Multifocal necrotizing leukoencephalopathy is a distinct entity usually localized to the basis pontis and is most consistently associated with immunosuppression, but as yet lacks other clearly defined clinical correlates. © 1993.
引用
收藏
页码:897 / 904
页数:8
相关论文
共 28 条
  • [1] ANDERS KH, 1986, AM J PATHOL, V124, P537
  • [2] MULTIFOCAL PONTINE LEUKOENCEPHALOPATHY - A CLINICOPATHOLOGICAL STUDY OF 3 CASES
    ANG, LC
    HEATHCOTE, JG
    GILBERT, JJ
    [J]. JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY, 1986, 45 (03) : 350 - 350
  • [3] EXTENSIVE EXTRAPONTINE AND CENTRAL PONTINE MYELINOLYSIS ASSOCIATED WITH CORRECTION OF PROFOUND HYPONATREMIA
    BOON, AP
    POTTER, AE
    [J]. NEUROPATHOLOGY AND APPLIED NEUROBIOLOGY, 1987, 13 (01) : 1 - 9
  • [4] BREUER AC, 1978, CANCER, V41, P2112, DOI 10.1002/1097-0142(197806)41:6<2112::AID-CNCR2820410607>3.0.CO
  • [5] 2-W
  • [6] BRAIN CALCIFICATION IN SEVERELY STRESSED NEONATES RECEIVING PARENTERAL CALCIUM
    CHANGARIS, DG
    PUROHIT, DM
    BALENTINE, JD
    LEVKOFF, AH
    HOLDEN, AEC
    DEAN, DL
    BIGGS, PJ
    [J]. JOURNAL OF PEDIATRICS, 1984, 104 (06) : 941 - 946
  • [7] EPSTEIN LG, 1988, PEDIATRICS, V82, P355
  • [8] CENTRAL PONTINE MYELINOLYSIS AFTER LIVER-TRANSPLANTATION
    ESTOL, CJ
    FARIS, AA
    MARTINEZ, AJ
    AHDABBARMADA, M
    [J]. NEUROLOGY, 1989, 39 (04) : 493 - 498
  • [9] NEUROPATHOLOGIC FINDINGS AFTER LIVER-TRANSPLANTATION
    FERRIRO, JA
    ROBERT, MA
    TOWNSEND, J
    VINTERS, HV
    [J]. ACTA NEUROPATHOLOGICA, 1992, 84 (01) : 1 - 14
  • [10] GIANGASPERO F, 1988, ARCH PATHOL LAB MED, V112, P1259