Acute Disseminated Postinfectious and Postvaccination Encephalomyelitis

Acute disseminated postinfectious and postvaccination encephalomyelitis develops 1 to 3 weeks following a

FIGURE 8.14

Balo's concentric sclerosis shows zones of myelin losses alternating with zones of intact myelin in a circular fashion (myelin stain).

viral or bacterial infection such as measles, varicella, rubella, influenza, mumps, infectious mononucleosis, or scarlet fever, or it develops following vaccination for rabies, smallpox, measles, typhoid, and paratyphoid.

The onset is acute with headaches, fever, meningeal signs, focal neurologic deficits, and often seizures. The disease resolves within several weeks, and the course is monophasic. The outcome varies from full recovery through variable residual neurologic impairment to death, which occurs in about 20% to 30% of cases.

Grossly, the brain and spinal cord are swollen and congested. The histology is characterized by periven-ous inflammatory demyelination. Lymphocytes and lipid-laden macrophages fill the demyelinated zones (Fig. 8.16).

Bal Concentric Sclerosis Pathology

FIGURE 8.15

Schilder's disease in a 40-year-old woman. Extensive demye-lination in one frontal lobe extends into the corpus callosum (PTAH).

FIGURE 8.14

Balo's concentric sclerosis shows zones of myelin losses alternating with zones of intact myelin in a circular fashion (myelin stain).

FIGURE 8.15

Schilder's disease in a 40-year-old woman. Extensive demye-lination in one frontal lobe extends into the corpus callosum (PTAH).

Perivenous Encephalomyelitis

FIGURE 8.16

Acute disseminated perivenous encephalomyelitis. A and B. Spinal cord showing demyelination along radially oriented veins (myelin stain). C. Dense infiltrations with neutrophils, lymphocytes, and macrophages in the demyelinated zones (cresyl violet).

FIGURE 8.16

Acute disseminated perivenous encephalomyelitis. A and B. Spinal cord showing demyelination along radially oriented veins (myelin stain). C. Dense infiltrations with neutrophils, lymphocytes, and macrophages in the demyelinated zones (cresyl violet).

FIGURE 8.17

Acute hemorrhagic leukoencephalitis. A 42-year-old man, with a 3-week history of muscle and stomach aches and cough, suddenly developed headaches, neck pain, fever, and left hemiparesis. Four days later, he became hemiplegic and comatose. Six days after the headaches began, he died. Grossly, the hemispheric white matter displayed multiple petechial hemorrhages. Histologic section shows fibrinoid necrosis of a small vessel, dense perivascular and diffuse parenchymal infiltrations with neutrophils and lymphocytes, and small hemorrhages (HE).

FIGURE 8.17

Acute hemorrhagic leukoencephalitis. A 42-year-old man, with a 3-week history of muscle and stomach aches and cough, suddenly developed headaches, neck pain, fever, and left hemiparesis. Four days later, he became hemiplegic and comatose. Six days after the headaches began, he died. Grossly, the hemispheric white matter displayed multiple petechial hemorrhages. Histologic section shows fibrinoid necrosis of a small vessel, dense perivascular and diffuse parenchymal infiltrations with neutrophils and lymphocytes, and small hemorrhages (HE).

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