Table 15.

Metachromatic leukodystrophy: Pathologic findings

•Destruction of myelin in the cerebral and cerebellar white matter

•Gliosis

•Ballooned macrophages (vacuolated)

•Metachromatic staining of sulfatides in macrophages and white matter

–Basic dyes (e.g., acidified cresyl violet and toluidine blue) stain different colors when

they react with the tissue

–Frozen section tissue must be used

•Subcortical arcuate fibers may be spared

•EM: Prismatic inclusions, representing accumulated sulfatides, can be seen in all tissues