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Brain, Vol. 126, No. 3, 515-530, March 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg061

Review Article

Axonal damage: a key predictor of outcome in human CNS diseases

I. M. Medana1 and M. M. Esiri2,3

Departments of 1 Clinical Laboratory Sciences and 2 Clinical Neurology, University of Oxford and 3 Department of Neuropathology, Oxford Radcliffe NHS Trust, Oxford, UK

Correspondence to: Professor M. M. Esiri, Neuropathology Department, Radcliffe Infirmary, Oxford OX2 6HE, UK E-mail: margaret.esiri{at}clneuro.ox.ac.uk

Axonal damage has recently been recognized to be a key predictor of outcome in a number of diverse human CNS diseases, including head and spinal cord trauma, metabolic encephalopathies, multiple sclerosis and other white-matter diseases (acute haemorrhagic leucoencephalitis, leucodystrophies and central pontine myelinolysis), infections [malaria, acquired immunodeficiency syndrome (AIDS) and infection with human lymphotropic virus type 1 (HTLV-I) causing HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP)] and subcortical ischaemic damage. The evidence for axonal damage and, where available, its correlation with neurological outcome in each of these conditions is reviewed. We consider the possible pathogenetic mechanisms involved and how increasing understanding of these may lead to more effective therapeutic or preventive interventions.


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