Abstract
Vacuolar myelopathy (VM) and tract pallor are poorly understood spinal tract abnormalities in patients with the acquired immunodeficiency syndrome (AIDS). We studied the ability of magnetic resonance imaging (MRI) to detect these changes in spinal cord specimens postmortem and whether criteria could be formulated which would allow these conditions to be differentiated from other lesions of the spinal cord in AIDS, such as lymphoma, cytomegalovirus (CMV) and human immunodeficiency virus (HIV) myelitis. We imaged 38 postmortem specimens of spinal cord. The MRI studies were interpreted blind. The specimens included cases of VM myelin pallor, CMV myeloradiculitis, HIV myelitis, lymphoma as well as normal cords, both HIV+ve and HIV-ve. MRI showed abnormal signal, suggestive of tract pathology, in 10 of the 14 cases with histopathological evidence of tract changes. The findings in VM and tract pallor on proton-density and T2-weighted MRI were increased signal from the affected white-matter tracts, present on multiple contiguous slices and symmetrical in most cases. The pattern was sufficiently distinct to differentiate spinal tract pathology from other spinal cord lesions in AIDS.
Similar content being viewed by others
References
Gans J de, Portegies P (1989) Neurological complications of infection with human immunodeficiency virus type 1. A review of literature and 241 cases. Clin Neurol Neurosurg 91: 199–219
Gabuzda DH (1990) Neurologic disorders associated with HIV infections. J Am Acad Dermatol 22: 1232–1236
Carvlin MJ, Asato R, Hackney DB, Kassab E, Joseph PM (1989) Highresolution MR of the spinal cord in humans and rats. AJNR 10: 13–17
Solsberg MD, Lemaire C, Resch L, Potts DG (1990) High-resolution MR imaging of the cadaveric human spinal cord: normal anatomy. AJNR 11: 3–7
Okumura R, Asato R, Shimada T, Kusaka H, Mizutani T, Miki Y, Konishi J (1992) Degeneration of the posterior columns of the spinal cord: postmortem MRI and histopathology. J Comput Assist Tomogr 16: 865–867
Pant SS, Ashbury AK, Richardson EP Jr (1968) The myelopathy of pernicious anemia: a neuropathological reappraisal. Acta Neurol Scand 44: 1–36
Robertson DM, Dinsdale HB, Campbell RJ (1971) Subacute combined degeneration of the spinal cord: no association with vitamin B12 deficiency. Arch Neurol 24: 203–207
DeMeyer W, Gebhard RL (1975) Subacute degeneration of the spinal cord with cystinuria. Neurology 25: 994–997
Devinsky O, Petito CK, Alonso DA (1988) Clinical and neuropathological findings in systemic lupus erythematosis the role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura. Ann Neurol 23: 380–384
Johnson RT, Richardson EP Jr (1968) The neurological manifestations of systemic lupus erythematosis. Medicine 47: 337–369
Powell HC, Myers RR, Lampert PW (1980) Edema in neurotoxic injury. In: Spencer PS, Schaumberg HH (eds) Experimental and clinical neurotoxocology. Williams and Wilkins, Baltimore, pp 118–138
Towfighi J (1980) Hexachlorophane. In: Spencer PS, Schaumberg HH (eds) Experimental and clinical neurotoxocology. Williams and Wilkins, Baltimore, pp 440–445
Petito CK, Navia BA, Cho E-S, Jordan BD, George DC, Price RW (1985) Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome. N Engl J Med 312: 874–879
Snider WD, Simpson DM, Nielson S, Gold GW, Metroka CE, Postner JB (1983) Neurological complications of acquired immune deficiency syndrome; analysis of 50 patients. Ann Neurol 144: 403–418
Goldstick L, Mandybur TI, Means E (1984) Spinal cord long tract degeneration in AIDS. J Neuropathol Exp Neurol 43: 294
Goldstick L, Mandybur TI, Bode R (1985) Spinal cord degeneration in AIDS. Neurology 35: 103–106
Anders KH, Guerra WF, Tomiyasu U, Verity MA, Vinters HV (1986) The neuropathology of AIDS. UCLA experience and review. Am J Pathol 124: 537–558
Monte SM de la, Ho DD, Schooley RT, Hirsh MS, Richardson E Jr (1987) Subacute encephalomyelitis of AIDS and its relation to HTLV-111 infection. Neurology 37: 562–569
Sccaravilli F, Sinclair E, Arango J-C, Manji H, Lucas S, Harrisson MJG (1992) The pathology of the posterior root ganglia in AIDS and its relationship to pallor of the gracile tract. Acta Neuropathol 84: 163–170
Artigas J, Grosse G, Niedobitek F (1990) Vacuolar myelopathy in AIDS. A morphological analysis. Pathol Res Pract 186: 228–237
Rance NE, McArthur JC, Cornblath DR, Landstrom DL, Griffin JW, Price DL (1988) Gracile tract degeneration in patients with sensory neuropathy and AIDS. Neurology 38: 265–271
Dickson DW, Belman AL, Horoupain DS, Rubenstein A (1989) Spinal cord pathology in pediatric acquired immunodeficiency syndrome. Neurology 39: 227–235
Hénin D, Smith TW, De Girolami U, Sughayer M, Hauw J-J (1992) Neuropathology of the spinal cord in the acquired immunodeficiency syndrome. Hum Pathol 23: 1106–1114
Singh BM, Levine S, Yarrish RL, Hyland MJ, Jeanty D, Wormser GP (1986) Spinal cord syndromes in the acquired deficiency syndrome. Acta Neurol Scand 73: 590–598
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Santosh, C.G., Bell, J.E. & Best, J.J.K. Spinal tract pathology in AIDS: Postmortem MRI correlation with neuropathology. Neuroradiology 37, 134–138 (1995). https://doi.org/10.1007/BF00588630
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00588630