Brain spectrin is a major membrane skeleton protein that participates in cellular transport, cell morphogenesis, neurotransmitter release and growth cone adhesion. The present study showed that in Alzheimer disease (AD) neuropil, brain spectrin immunoreactivity is co-localized with synaptophysin in the presynaptic boutons. At the ultrastructural level, brain spectrin immunoreactivity was observed in the presynaptic terminals and in the axoplasm of some myelinated and unmyelinated fibers. In addition to this normal localization of brain spectrin in the AD brain, we also found brain spectrin immunoreactivity associated with abnormal patchy lesions in the AD neuropil. Confocal laser imaging and immunoelectron microscopy revealed that these lesions corresponded to thick cellular processes derived from neurons. The findings that these structures were anti-neurofilament positive but anti-glial fibrillary acidic protein (GFAP) and Ricinus communis agglutinin I (RCA-I) negative confirm their neuronal origin, and rule out the possibility of glial origin. These structures could represent either atypical axonal or dendritic processes derived from sprouting neurons or the accumulation of brain spectrin degradation products in degenerating neurons.