Abstract
Twenty of 89 consecutive patients with the acquired immunodeficiency syndrome (AIDS) in whom autopsies were performed over a 3 1/2-year period had a vacuolar myelopathy that was most severe in the lateral and posterior columns of the thoracic cord. Light and electron microscopy showed that vacuoles were surrounded by a thin myelin sheath and appeared to arise from swelling within myelin sheaths. Signs and symptoms referable to the spinal-cord lesions, including paraparesis, often accompanied by spasticity or ataxia (or both), were present in all five patients with marked pathological changes, in five of seven patients with moderate changes, and in two of eight patients with mild changes. Fourteen patients were demented. The clinical presentation was sufficiently distinctive to provide a guide for antemortem diagnosis. Possible causes of the vacuolar changes include uncharacterized viral infection or a metabolic derangement related to selective nutritional deficiency. (N Engl J Med 1985; 312: 874–9.)
Central nervous system involvement frequently complicates the acquired immunodeficiency syndrome (AIDS). Approximately 30 per cent of patients with AIDS have clinically apparent central nervous system dysfunction, and 80 per cent have neuropathological abnormalities at postmortem examination.
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We describe here the clinical and neuropathological features of a previously uncharacterized vacuolar myelopathy that was found in 20 of 89 patients with AIDS who were examined at autopsy at New York Hospital and at Memorial Sloan–Kettering Cancer Center over a 3 1/2-year period.
Methods
Brains and spinal cords from 89 patients with AIDS in whom autopsies were performed between September 1980 and May . . .
