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We describe the sural nerve pathology in 3 patients with HTLV-I-associated myelopathy(HAM).These patients showed remarkable symptoms of myelopathy and had high HTLV-I titers in the serum and CSF.The common pathologic findings in the sural nerves were as follows:slightly decreased density in myelinated]fibers(6,567/mm2,6,488/mm2,and 7,159/mm2,control,9,999+/-3,446/ mm2),frequent occurrence of demyelinated and remyelinated fibers,and many degenerating fibers with globule-like myelin changes.Teased-fiber analysis indicated the globule-like changes(Dyck's G change)to be accompanied by the formation of adjacent demyelinated segments.The globules result from slowly repetitive degenerative changes of myelin and are considered to be a form of demyelination.However,they have seldom been found in other demyelinating neuropathies,indicating the demyelination process with globule formation in HAM to be rather specific for this disease. |
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