Rance N E, McArthur J C, Cornblath D R, Landstrom D L, Griffin J W, Price D L
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Neurology. 1988 Feb;38(2):265-71. doi: 10.1212/wnl.38.2.265.
At autopsy, four homosexual men with acquired immunodeficiency syndrome (AIDS) were found to have selective degeneration of the gracile tract, a finding previously unreported in AIDS. Clinically, these patients had progressive lower extremity paresthesias and dysesthesias with reduced or absent ankle jerks, and eventually they developed dementia. Postmortem examination of spinal cords showed a striking loss of both axons and myelin sheaths confined to the fasciculus gracilis, with the most severe involvement in upper thoracic or cervical segments. Lumbar dorsal columns showed only a mild fiber loss, and no fiber loss was observed in lumbar dorsal roots. Lumbar dorsal root ganglia were available from one patient and showed a mild sensory ganglionitis. In all cases examined, microglial nodules were present in the brain. In 23 other individuals with AIDS who had autopsies consecutively with these four subjects, none had sensory neuropathy and the gracile tracts were normal. The combination of distal sensory neuropathy and gracile tract degeneration suggests a "dying-back" process of dorsal root ganglia neurons.
尸检发现，四名患有获得性免疫缺陷综合征（艾滋病）的同性恋男子存在薄束选择性变性，这一发现此前在艾滋病患者中未见报道。临床上，这些患者出现进行性下肢感觉异常和感觉障碍，踝关节反射减弱或消失，最终发展为痴呆。脊髓的尸检显示，仅限于薄束的轴突和髓鞘显著丧失，上胸段或颈段受累最为严重。腰段后柱仅显示轻度纤维丧失，腰段背根未观察到纤维丧失。从一名患者获取的腰段背根神经节显示轻度感觉神经节炎。在所有检查的病例中，大脑均存在小胶质细胞结节。在与这四名受试者连续进行尸检的其他23名艾滋病患者中，无一例有感觉神经病变，薄束均正常。远端感觉神经病变与薄束变性的结合提示背根神经节神经元存在“逆行性”病变过程。
