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FIG 6. A and B, Postmortem axial T2-weighted images of the midbrain (A) and pons (B) 28 months after the onset of symptoms in case 5, showing hyperintensities in the cerebral peduncles (A, arrows), pons (B, arrows), and middle cerebellar peduncles (B, arrowheads) involving the longitudinal fasciculi, pontine nuclei, and pontine transverse fibers. C and D, The myelin-stained sections corresponding to panels A and B demonstrate severe pallor of the cerebral peduncles (C), pons, and middle cerebellar peduncles (D). E, Histologically, the cerebral peduncle shows severe loss of myelin and axons with moderate macrophage infiltration (arrowheads) and fibrillary gliosis, characteristics compatible with secondary degeneration. F, Pontine nuclei reveal neuronal loss and proliferation of hypertrophic astrocytes (arrows). G, Middle cerebellar peduncle shows severe loss of myelin and axons with moderate macrophage infiltration (arrowheads) but no gemistocytic astrocytes, a characteristic compatible with secondary degeneration.
