Advertisement

Acta Neuropathologica

, Volume 81, Issue 2, pp 198–203 | Cite as

Axonal atrophy in the painful peripheral neuropathy in AIDS

  • G. N. Fuller
  • J. M. Jacobs
  • R. J. Guiloff
Regular Papers

Summary

We compared the sural nerves from patients with AIDS; four with the painful peripheral neuropathy (PPN), three patients with non-painful distal symmetrical peripheral neuropathy (DSPN), one without clinical peripheral nerve involvement and two human immunodeficiency virus negative controls. Fibre diameter distributions showed a slight reduction in larger fibres in all patients with AIDS compared with controls. No significant difference was found in the relative frequency distribution of the lamellae counts between any of the groups. The relative frequency distribution of axonal area of myelinated fibres did not differ between controls, non-pailful DSPN or the patient without peripheral nerve involvement; however, all patients with PPN showed marked reduction in the number of axons of myelinated fibres of larger area which was significant when compared to each patient from the other groups (P<0.0001). This indicates that the reduction in larger fibres in PPN is mostly due to axonal atrophy rather than selective fibre loss. Axonal atrophy is associated with painful peripheral neuropathy in AIDS but not with those without pain. The possible role of axonal atrophy as a pathological substrate for pain is discussed.

Key words

AIDS Pain Neuropathy Axonal atrophy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Arbuthnott ER, Ballard KJ, Boyd IA, Kalu KU (1980) Quantitative study of the non-circularity of myelinated peripheral nerve fibres in the cat. J Physiol 308:99–123Google Scholar
  2. 2.
    Archer AG, Watkins PJ, Thomas PK, Sharma AK, Payan J (1983) The natural history of acute painful neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry 46:491–499Google Scholar
  3. 3.
    Asbury AK (1984) Uremic neuropathy. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. WB Saunders, Philadelphia, pp 1811–1825Google Scholar
  4. 4.
    Brown MJ, Martin JR, Asbury AK (1976) Painful peripheralneuropathy: a morphometric study. Arch Neurol 33:164–171Google Scholar
  5. 5.
    Centre for Disease Control (1987) Revision of CDC surveillance case definition for acquired immunodeficiency syndrome. Morbidity and Mortality Weekly Report 36 [Suppl]:1–5Google Scholar
  6. 6.
    Cornblath DR, McArthur JC (1988) Predominantly sensory neuropathy in patients with AIDS and AIDS releated complex. Neurology 38:794–796Google Scholar
  7. 7.
    Dyck PJ (1984) Inherited neuronal degeneration and atrophy affecting peripheral motor, sensory, and autonomic neurons. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. WB Saunders, Philadelphia, pp 1600–1655Google Scholar
  8. 8.
    Dyck PJ, Johnson WJ, Lambert EH, O'Brien PC (1971) Segmental demyelination secondary to axonal degeneration in uraemic neuropathy. Mayo Clin Proc 46:400–431Google Scholar
  9. 9.
    Dyck PJ, Lambert EH, O'Brien PC (1976) Pain in peripheral neuropathy related to rate and kind of fiber degeneration. Neurology 26:466–471Google Scholar
  10. 10.
    Dyck PJ, Nukada H, Lais AC, Karnes JL (1984) Permanent axotomy: a model of chronic neuronal degeneration preceeded by axonal atrophy, myelin remodeling, and degeneration. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. WB Saunders, Philadelphia, pp 666–690Google Scholar
  11. 11.
    Friede RL, Bischhausen R (1980) The precise geometry of large internodes. J Neurol Sci 48:367–381Google Scholar
  12. 12.
    Friede RL, Bischhausen R (1982) How are sheath dimensions affected by axon calibre and internode length? Brain Res 235:335–350Google Scholar
  13. 13.
    Fuller GN, Jacobs JM, Guiloff RJ (1989) Association of painful peripheral neuropathy in AIDS with cytomegalovirus infection. Lancet II:937–941Google Scholar
  14. 14.
    Gastaut JL, Gastaut JA, Pellissier JF, Tapko JB, Weill O (1989) Neuropathies périphériques au cours de l'infection par le virus de l'immunodeficience humaine. Rev Neurol (Paris) 145:451–459Google Scholar
  15. 15.
    Griffin JW, Watson DF (1988) Axonal transport in neurological disease. Ann Neurol 23:3–13Google Scholar
  16. 16.
    Jacobs JM, Love S (1985) Qualitative and quantitative morphology of human sural nerve at different ages. Brain 108:897–924Google Scholar
  17. 17.
    Karnes J, Robb R, O'Brien PC, Lambert EH, Dyck PJ (1977) Computerised image recognition for morphometry of nerve attribute of shape of sampled transverse section of myelinated fibers which best estimate their average diameter. J Neurol Sci 34:43–51Google Scholar
  18. 18.
    Lange DJ, Britton CB, Younger DS, Hays AP (1988) The neuromuscular manifestations of human immunodeficiency virus infections. Arch Neurol 45:1084–1088Google Scholar
  19. 19.
    Léger JM, Bouche P, Bolgert F, Chaunu MP, Rosenheim M, Cathala HP, Gertilini M, Hauw JJ, Brunet P (1989) The spectrum of polyneuropathies in patients infected with HIV. J Neurol Neurosurg Psychiatry 52:1369–1374Google Scholar
  20. 20.
    Mah V, Vartavarian LM, Akers MA, Vinters HV (1988) Abnormalities of peripheral nerve in patients with human immunodeficiency virus infection. Ann Neurol 24:713–717Google Scholar
  21. 21.
    McLeod JG, Walsh JC, Pollard JD (1984) Neuropathies associated with paraproteinemias and dysproteinemias. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. WB Saunders, Philadelphia, pp 1847–1865Google Scholar
  22. 22.
    Miller RG, Parry GJ, Pfaeffl W, Lang W, Lippert R, Kiprov D (1988) The spectrum of peripheral neuropathy associated with ARC and AIDS. Muscle Nerve 11:857–863Google Scholar
  23. 23.
    Noordenbos W, Wall PD (1981) Implications of the failure of nerve resection and graft to cure chronic pain produced by nerve lesions. J Neurol Neurosurg Psychiatry 44:1068–1073Google Scholar
  24. 24.
    O'Neill JH, Jacobs JM, Gilliatt RW, Baba M (1984) Changes in the compact myelin of single internodes during axonal atrophy. Acta Neuropathol (Berl) 63:313–318Google Scholar
  25. 25.
    Ohi T, Kyle RA, Dyck PJ (1985) Axonal attenuation and secondary segmental demyelination in myeloma neuropathies. Ann Neurol 17:255–261Google Scholar
  26. 26.
    Said G, Marion MH, Selva J, Jamet C (1986) Hypotrophic and dying-back nerve fibres in Friedreich's ataxia. Neurology 36:1292–1299Google Scholar
  27. 27.
    Schröder JM, Seiffert KE (1972) Untersuchungen zur homologen Nerventransplantation. Zentralbl Neurochirurg 53:103–118Google Scholar
  28. 28.
    Sharma AK, Britland ST, Young RJ, Malik RA, Mewrik PG, Boulton AJM, Ward JD (1990) Morphological abnormalities in the sural nerve of patients with and without clinical, syndromes of diabetic neuropathy. In: Ward J, Goto Y (eds) Diabetic neuropathy. John Wiley and sons, New York, pp 29–45Google Scholar
  29. 29.
    Thomas PK, Scadding JW (1987) Treatment of pain in diabetic neuropathy. In: Dyck PJ, Thomas PK, Asbury AK, Winegrad AI, Porte D (eds) Diabetic neuropathy. WB Saunders, Philadelphia, pp 216–222Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • G. N. Fuller
    • 1
    • 2
  • J. M. Jacobs
    • 1
  • R. J. Guiloff
    • 2
  1. 1.Department of NeuropathologyInstitute of NeurologyLondonGreat Britain
  2. 2.Department of NeurologyWestminster Hospital, Charing Cross and Westminster Medical SchoolLondonGreat Britain

Personalised recommendations