CASE STUDIES

Case 1. A 54 year old woman with Hodgkin's disease was treated with immuno- suppressive agents for 5 years. She developed hemiplegia and coma and was thought to have a "stroke". In one softened demyelinated lesion in the cerebral hemisphere opposite the hemiparesis were many oligodendroglial inclusions and bizarre astrocytes. DIAGNOSIS: progressive multifocal leukoencephalopathy

This high power microscopic view shows giant bizarre astrocytes in a case of progressive multifocal leukoencephalopathy.

This image shows oligodendrocyte nuclear inclusions in a case of progressive multifocal leukoencephalopathy.

Case 2. A 33-year-old woman who had been in good health complained of blurred vision and difficulty walking on her left leg. These symptoms improved after a few weeks. Nine months later she experienced another episode, with blurred vision, nystagmus, weakness in her left leg, Babinski sign on the left, and dysarthria. CSF examination showed increased protein, increased gamma-globulin and oligoclonal bands. DIAGNOSIS: multiple sclerosis

Several multiple sclerosis plaques are seen adjacent to the lateral ventricles in this coronal section. A good example is at the upper right of the ventricle on the right side of the screen.

Several grayish multiple sclerosis plaques are adjacent to the occipital horns of the lateral ventricles. Choroid plexus is seen within the ventricles.

Case 3. A 25-year-old man complained of headaches, nausea, and vomaiting. He was thought to have the "flu" and was treated symptomatically. Four days later he was taken to the emergency room because of inappropriate behavior, reports of hallucinations, confusion, nausea and vomiting. He had a temperature of 99.8F. Lumbar puncture revealed clear CSF containing 43 WBC/mm3, predominantly mononuclear cells. Glucose and protein were within normal limits. Despite treatment with acyclovir, he continued to deteriorate and died after 5 days in the hospital. Hemorrhagic necrosis was present in the temporal lobes and cingulate gyrus. Microscopic examination showed perivascular cuffing and neuronal inclusion bodies. DIAGNOSIS: herpes simplex encephalitis

This coronal section focuses on the cingulate gyrus showing patchy hemorrhagic necrosis in a case of herpes simplex encephalitis.

Case 4. A 9-year-old previously healthy girl was taken to the emergency room by her parents. A day and a half earlier she began having fever, lethargy, vomiting, and headache. She had gradually become worse and had become delirious. Examination revealed nuchal rigidity, confusion and a temperature of 102F. Lumbar puncture revealed cloudy CSF, with 8000 WBC/mm3, 25 mg/dl glucose, 267 mg/dl protein. Gram-positive diplococci were present. DIAGNOSIS: acute purulent meningitis

This dorsal view of the brain in the skull illustrates purulent meningitis with opague meninges due to the dense infiltrate.

Case 5. After a complex history of mental illness, a 40 year old woman developed memory deficits, bizarre behavior, myoclonus, weakness and spasticity. Cerebellar ataxia was present. Several months after onset of neurological signs, she became comatose with decerebrate posturing. Examination of brain biopsy showed spongiform encephalopathy. DIAGNOSIS: Creutzfeldt-Jakob disease

This microscopic image shows spongiform encephalopathy in a case of Creutzfeldt-Jakob disease.

Prominent gliosis in Creutzfeldt-Jakob disease is illustrated in this image.

| Previous Section |

| Course Index |

| Section Index |