Basal ganglia, thalamus, cerebral cortex, and subcortical white matter were studied in ten cases of hepatic encephalopathy (HE), including three cases of acquired hepatocerebral degeneration (HCD), and in thirteen age-matched controls using the peroxidase-antiperoxidase immunohistochemical staining technique for glial fibrillary acidic (GFA) protein. HE cases all had pronounced Alzheimer type II astrocytosis. The perikarya and processes of Alzheimer type II glia did not stain for GFA protein. Staining of perivascular endfeet was evaluated by first selecting blood vessels throughout the gray and white matter in hematoxylin and eosin-stained slides to eliminate bias. The vessels were then identified in sections stained for GFA protein and graded as to complete circumferential, partial circumferential, or absence of staining. Both the degree and frequency of staining in the basal ganglia, thalamus, and cerebral cortex were significantly decreased in cases of HE; no statistically significant differences were found for the white matter. There were no significant differences in staining between HCD and other HE cases. These findings show that the Alzheimer II change is associated with a loss of immunohistochemically detectable GFA protein in cerebral gray matter.
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