Numerous ballooned neurons in a 94-year-old man with dementia with Lewy bodies

Published:February 04, 2020DOI:https://doi.org/10.1016/j.jns.2020.116722
      Cortical swollen neurons with achromasia, described as ballooned neurons (BNs), are hallmark of neurodegenerative diseases such as Pick body disease, corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), and argyrophilic grain disease (AGD) [
      • Lowe J.S.
      • Leigh N.
      Disorders of movement and system degenerations.
      ]. BNs are also found less frequently in Alzheimer's disease (AD) and Parkinson's disease (PD), while their role in pathological differentiation remains to be clarified [
      • Dickson D.W.
      • Feany M.B.
      • Yen S.H.
      • Mattiace L.A.
      • Davies P.
      Cytoskeltal pathology in non-Alzheimer degenerative dementia: new lesions in diffuse Lewy body disease, Pick’s disease, and corticobasal degeneration.
      ]. We experienced an autopsy case with abundant BNs in a 94-year-old man with clinico-pathologically confirmed dementia with Lewy bodies (DLB). A small number of tufted astrocytes were detected in the basal ganglia, and some argyrophilic grains were scattered in the medial temporal cortices. Although it remains unclear how these different cytopathologies (Lewy pathology, BNs, tufted astrocytes, and grains) are related or co-occur by chance, the overlapping distribution of BNs and cortical Lewy bodies (LBs) suggests a mutual pathogenetic association. The possible contribution of Lewy pathology to the presence of BN is discussed here, with a literature review.

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