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α-Synuclein Immunoreactivity Is Present in Axonal Swellings in Neuroaxonal Dystrophy and Acute Traumatic Brain Injury

Kathy L. Newell MD, Philip Boyer MD, PhD, Estrella Gomez-Tortosa MD, PhD, Wendy Hobbs BA, E. Tessa Hedley-Whyte MD, Jean Paul Vonsattel MD, Bradley T. Hyman MD, PhD
DOI: http://dx.doi.org/10.1097/00005072-199912000-00007 1263-1268 First published online: 1 December 1999


The primary neuroaxonal dystrophics (NAD), which include infantile NAD and Hallervorden-Spatz syndrome (HSS), are characterized by dystrophic terminal axons and axonal swellings. Lewy bodies have been found in some cases. In Parkinson disease (PD) and dementia with Lewy bodies (DLB), Lewy bodies and neurites display prominent α-synuclein immunoreactivity. We examined 2 cases of HSS and 4 cases of infantile NAD with α-synuclein immunohistochemistry to test the hypothesis that these disorders with similar morphological findings might share a biochemical phenotype. Furthermore, we compared them to 8 cases of secondary or physiologic NAD of various causes and 2 cases of recent traumatic head injury. α-Synuclein positive neuronal cytoplasmic inclusions, including Lewy bodies, and neurites were numerous in 1 HSS and 1 infantile NAD case. In addition, axonal spheroids were immunostained in all 6 cases of primary NAD, 5 cases of secondary NAD, and 2 cases of recent head injury. Axonal spheroids were faintly stained in the 3 physiologic NAD cases. α-Synuclein positive axonal swellings may suggest a mechanism, such as axonal injury, leading to the neuronal cytoplasmic accumulation of α-synuclein in NAD and other disorders.

Key Words
  • α-synuclein
  • Axonal spheroids
  • Axonal swellings
  • Diffuse axonal injury
  • Hallervorden-Spatz syndrome
  • Lewy body
  • Neuroaxonal dystrophy