We performed standard histological, immunohistochemical, and ultrastructural examinations of formalin Wxed samples of the brain (frontal cortex, brain stem, basal ganglia, and spinal medulla) of a male patient, aged 12, who succumbed to a mitochondrial disorder, characterized as MERRF (8344A > G). Neuropathology revealed regressive neuronal changes including necrotic foci [9]. Necroses were localized subependymally in the brain stem and in the ventral part of the spinal medulla, where it communicated with the leptomeningeal space. There was prominent generalized astrocytosis in all samples examined. GFAP and S100 immunostaining showed remarkably dense networks of astrocyte processes, which often had a beaded appearance. In the cerebral cortex, astrocytosis was restricted to the Wrst two cortical layers. The subarachnoid space was frequently thickened by a loose, variably cellular population of spindle-shaped cells positive for vimentin and S100 protein, but negative for GFAP. In several subarachnoid regions, the cells were condensed to relatively dense bands which were not only vimentin and S100 protein positive, but also strongly stained for GFAP. They were frequently in contact with the adventitia of otherwise normal appearing subarachnoid arteries (Fig. 1a). In the brain stem region (lateral side of the tegmentum) small leptomeningeal arteries were completely encircled by a thick, dense concentric cuV-like layer of Wbrous astrocytes (Fig. 1b–d) which were either isolated or only in partial contact with the subpial astrocytic mass (Fig. 1e, f). Cells of the astrocytic cuVs stained strongly for GFAP (Fig. 1b) and S100 protein; however, only a few expressed vimentin. The perivascular concentric astrocytic bands displayed discrete laminin positivity at the periphery. The entangled vessels were compressed, leaving only slit-like lumens or were completely occluded (Fig. 1c, d). Electron microscopy, carried out in paraYn sections from several leptomeningeal lesions, showed aggregates of intermediate Wlaments (t10 nm thick) identical to those found in the subpial astrocytes of the brain. Our observation of remarkable numbers of astrocytes in the leptomeningeal space is exceptional. Comparable observations are very rare [3–5, 7, 13]. Their presence might be related to the activation of proposed residential meningeo-glial network [6] which may lead to parallel activation of brain astrocytes. It is interesting that some of the tumors arising in the meningeal region express GFAP [1, 11, 12]. It is also worth mentioning that the astrocytic immunophenotype (GFAP, S100) has been seen in extracerebral mesenchymal cells, e.g., Wbroblasts and chondrocytes [2]. What is unique is the presence of perivascular cuV-like astrocytic bands leading to vascular compression. Linkage to subpial astrocytic hypertrophy suggests that they originated from this astrocyte subpopulation [8]. The presence of laminin at the periphery of the cuVs suggests a highly order arrangement comparable with the subpial gliobasal membrane. The spatial relationship between the vascular compressive lesions and the brain stem necrosis suggests H. H4lkova · M. Elleder (&) 1st Faculty of Medicine, Institute of Inherited Metabolic Disorders, Division B, Bldg.D, Ke Karlovu 2, 128 08 Prague 2, Czech Republic e-mail: melleder@cesnet.cz
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