Faculty Bibliography

Reviews the book, The Addict by Michael Stein (2009). This book is Stein's memoir of a 20-year career working with patients like Lucy. Whether she is telling the truth, whatever her true motivation, whether she will ever come back, this is enough for Stein. Lucy is one of the 11 million Americans who take opioids for nonmedical purposes. What distinguishes addiction from other illnesses, such as hypertension or asthma--and even from psychiatric illness--is that, with addiction, as Stein tells us, the story is the illness. Stein's use of narrative also describes the phenomenology of drug/opioid use and the development of addiction. The underrepresentation--because their incidence is so high--of psychiatric comorbidities are the flaws of what is otherwise a substantive, well-crafted, and highly readable work.

Progressive multifocal leukoencephalopathy (PML) typically affects the CNS white matter of the central nervous system. We present an human immunodeficiency virus-infected patient with polyomavirus JC infection restricted to granule cell neurons of the cerebellum and with corresponding neurological symptomatology. Magnetic resonance imaging demonstrated cerebellar atrophy without white matter lesions and stereotactic biopsy showed selective infection of the cerebellar granular cell layer, with preservation of Purkinje cells and absence of classic progressive multifocal leukoencephalopathy histopathology in underlying white matter. Evolution over 8 years was marked by symptomatic improvement corresponding to highly active antiretroviral therapy (HAART), with modest increase in CD4(+) T-cell counts. We propose to call this novel syndrome JCV granule cell neuronopathy (JCV GCN).

The role of axonopathy in myelin disorders recently has been examined. To investigate axonal pathologic changes in vacuolar myelopathy (VM), semiquantitative immunohistochemical stains for inflammation, axonal damage, and gliosis were performed on spinal cord sections from patients with AIDS with and without VM and from HIV-negative controls. Significant axonal damage was present in only moderate to severe VM, despite inflammation at all stages. The authors conclude that axonal damage is not present in early disease; it is present in moderate to severe vacuolar myelopathy and may contribute to clinical deficits in late stages of this disorder