Histologically, the formation of NIIs is detectable after 9 weeks of age in the restricted CNS regions similar to those in the human DRPLA brain. Despite the strong neurological phenotype, obvious neuronal loss is not observed in any brain region. Diffuse polyglutamine accumulation in neuronal nuclei occurs in some regions, including the basal ganglia at as early as post-natal day 4 and expands to multiple brain regions by 4 weeks of age, suggesting that this nuclear pathology is responsible for the onset of clinical phenotype. Interestingly, this mouse model shows generalized brain atrophy that commences synergistically
with the intranuclear accumulation of mutant proteins. It is now apparent that DRPLA brains share several polyglutamine-related changes
in their neuronal Wnt antagonist nuclei, in addition to the conventional pathology characterized by neuronal depletion. The extensive involvement of CNS regions by polyglutamine pathology suggests that neurons are affected much more widely than has been recognized previously. The dynamics of the lesion distribution, which varies depending on the CAG repeat sizes in the causative gene, may be responsible for a variety of clinical DNA Damage inhibitor phenotypes in DRPLA. It is likely that DRPLA has an aspect of neuronal storage disorders, and transcriptional and metabolic disturbances of affected neurons may play a pivotal role in the pathogenesis of the disease.25 The author would like to thank Dr Hitoshi Takahashi,
Department of Pathology, Brain Research Institute, Niigata University, for helpful suggestions, and Dr Arika Hasegawa, Department of Neurology, National Hospital Organization, Nishi-Niigata Chuo National Hospital, for MRI. This research was supported by a grant from the Research Committee for Ataxic Diseases, and the Research Grant (19A-4) for Nervous and Mental Disorders, from the Ministry of Health, Labor and Welfare, C59 mouse Japan. “
“We report hereby an autopsy case of sporadic mixed phenotype CJD without hereditary burden and a long-term clinical course. An 80-year old man was diagnosed with mild cognitive impairment 27 months before death, caused by bronchopneumonia and severe respiratory impairment. During this time, the patient developed gradual mental deterioration, some sleeping problems and myoclonus. Other clinical manifestations were progressive gait problems, language deterioration, presence of primitive reflexes and irritability. In keeping with those symptoms, a rapidly evolving dementia was clinically suspected. Cerebrospinal fluid test for 14-3-3 protein was negative. However, an abnormal EEG and MRI at end-stage of disease were finally consistent with CJD. Post-mortem examination revealed a massive cortical neuronal loss with associated reactive astrocytosis, also evident in the white matter.
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