Axonal damage: a key predictor of outcome in human CNS diseases

• Published in: Brain (London, England : 1878) Vol. 126; no. 3; pp. 515 - 530
• Main Authors: Medana, I. M., Esiri, M. M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2003; Oxford Publishing Limited (England)
• Subjects: acute haemorrhagic encephalitis; Adolescent; Adult; Aged; AHLE = acute haemorrhagic leucoencephalitis; AIDS = acquired immunodeficiency syndrome; AIDS Dementia Complex - pathology; axonal damage; Axons - pathology; Biological and medical sciences; Brain Diseases, Metabolic - pathology; Brain Ischemia - pathology; Central Nervous System Diseases - pathology; cerebral malaria; Child; Child, Preschool; Craniocerebral Trauma - pathology; DAI = diffuse axonal injury; Deltaretrovirus Infections - pathology; Demyelinating Diseases - pathology; Diffuse Axonal Injury - pathology; HAM = HTLV‐I‐associated myelopathy; HIV = human immunodeficiency virus; HIV encephalitis; HIV-1; HIVD = HIV dementia; HTLV‐I = human lymphotropic virus type 1; Human T-lymphotropic virus 1; Humans; ICP = increased intracranial pressure; Infant; Malaria, Cerebral - pathology; Medical sciences; Middle Aged; multiple sclerosis; Multiple Sclerosis - pathology; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; neuropathology; Spinal Cord Injuries - pathology; TAI = traumatic axonal injury; vascular dementia; β‐APP = β‐amyloid precursor protein; Human; Immunopathology; Encephalitis; Protozoal disease; Nervous system diseases; Multiple sclerosis; Vascular dementia; Prognosis; Malaria; axonal damage; Axon; AIDS; Parasitosis; Immune deficiency; acute haemorrhagic encephalitis; Cerebral disorder; Inflammatory disease; Infection; Viral disease; Central nervous system disease; Evolution; cerebral malaria; neuropathology; HIV encephalitis
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/awg061

Axonal damage has recently been recognized to be a key predictor of outcome in a number of diverse human CNS diseases, including head and spinal cord trauma, metabolic encephalopathies, multiple sclerosis and other white‐matter diseases (acute haemorrhagic leucoencephalitis, leucodystrophies and central pontine myelinolysis), infections [malaria, acquired immunodeficiency syndrome (AIDS) and infection with human lymphotropic virus type 1 (HTLV‐I) causing HTLV‐I‐associated myelopathy (HAM)/tropical spastic paraparesis (TSP)] and subcortical ischaemic damage. The evidence for axonal damage and, where available, its correlation with neurological outcome in each of these conditions is reviewed. We consider the possible pathogenetic mechanisms involved and how increasing understanding of these may lead to more effective therapeutic or preventive interventions.