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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Solvent vapor leukoencephalopathy | 1A6 Solvent Vapor Leukoencephalopathy (AANP 1995, Case 2) LFB-PAS 5
In this image the perivascular macrophagic infiltrate is well seen and individual cell content appears more coarse than the PAS content of macrophages in typical demyelinating diseases such as MS. Although the macrophages in the current case are round with a superficial resemblance to globoid cells in Krabbe disease, they are rarely multinucleate and the clinical scenario is different. There is also the possibility of confusion of Solvent Vapor Leukoencephalopathy (SVAL) with adult onset adrenoleukodystrophy (ALD). ALD differs from SVAL in the more confluent, non-perivascular appearance of myelin loss in ALD, typically presence in ALD of a sharp border with adjacent myelin, presence of inclusions in adrenal and testis cells in ADL, the absence of typical foamy macrophages in ALD, and the more substantive lymphocytic infiltrate in ADL. (LFB-PAS).
