PMC3014830_01
Initial brain MRI illustrates diffuse abnormal T2 FLAIR signal in the corona radiata, centrum semiovale, and subcortical white matter throughout all lobes (a)-(c). Followup MRI brain at 2 months was unchanged (d)-(f).
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fig1
T2 signal in the corona radiata, centrum semiovale, and subcortical white matter throughout all lobes. There was no abnormal contrast enhancement, and no foci of restricted diffusion (Figure 1). A repeat MRI after 2 months was unchanged from his initial MRI (Figure 1).
Cerebral cortex shows apparently normal neuronal density ((a) hematoxylin and eosin, x200 original magnifications). The histological changes in the biopsy center in the white matter show increased cellularity with reactive gliosis ((b) hematoxylin and eosin, x400; (c) anti-GFAP, x200), microglial activation ((d) anti-CD68, x200), and axonal changes, consistent with recent axonal injury ((e) anti-neurofilament, x400; (f) anti-B-APP, x200 all original magnifications) in the presence of abundant well-stained myelin ((g) luxol fast blue with hematoxylin and eosin, x200). Ultrastructural evaluation confirms axonal degeneration with myelin preservation (h).
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fig2
White matter also showed strong immunoreactivity with CD 68 and GFAP (Figure 2).