The lesion of multiple sclerosis

Abstract

Increased blood-brain barrier (BBB) permeability, important in the pathogenesis of MS, may be demonstrated as lesion enhancement with high-volume delayed CT (HVDCT). We studied 40 MS patients with history, neurologic examination, HVDCT, and MRI. In addition, 7 of the patients with enhancing CT lesions were followed with serial MRI for up to 3 years and 7 months. In 3 of these patients we repeated the HVDCT. Patients with enhancing lesions on CT were younger, had shorter duration of disease, and had more frequent clinical relapses than did patients without enhancement. More than half (56%) of the enhancing CT lesions were in the deep white matter, 23% were periventricular, and 21% were at the gray/white matter junction. Half the CT enhancing lesions, when followed by serial MRI, showed significant changes in lesion size. Although the majority (59%) of these lesions faded, some remained actively changing (25%) or became confluent with adjacent lesions (16%). In 48% of the MRI examinations that showed activity, some lesions were increasing in size while others were simultaneously decreasing in size. This study confirms that MS is a dynamic process in which recurrent episodes of BBB disruption and inflammation play a major role. Recurrent episodes of inflammation may well be a prelude to the largely irreversible changes of demyelination and gliosis.

Gadolinium enhancement in acute and chronic‐progressive experimental allergic encephalomyelitis in the guinea pig

“…First, there is a difference in the immunogen used to induce the two diseases, although whole homogenized CNS contains a large amount of MBP and EAE is a T-cell mediated autoimmune disease in which the T-cell antigen is MBP. Second, Gdenhancement is seen in both acute and subacutelchronic lesions in human MS, and can recur later in recrudescent older lesions (47 disease (MR and clinical) than the chronic-progressive group. Thus, the difference in Gd-DTPA enhancement may be influenced by the severity of the disease as observed in the Strain 13 model (38).…”

A pathology-MRI study of the short-T2 component in formalin-fixed multiple sclerosis brain

“…MRI has become a widely utilized tool in the diagnosis and management of MS. 1-3 Typically, T2-weighted and proton density scans are employed, 2 wherein MS plaques appear as bright hyperintense areas. [17][18][19] Recently, a pathologic study has shown that chronic hypointense lesions ("black holes") on T1-weighted scans are caused by tissue destruction, particularly axon loss. 12,13 Depending on the context, lesions are referred to as "active" with the presence of inflammation or ongoing demyelination.…”

Statins as potential therapeutic agents in multiple sclerosis

“…Despite data from animal studies and circumstantial clinical evidence from other disease entities such as cardiovascular disease [75], ischemic stroke [77][78][79][80], and dementia [81,82], it has yet to be determined whether statins will be beneficial in MS. Conducting retrospective studies to gather epidemiologic evidence that MS patients treated for hypercholesterolemia benefit from statin treatment has proven to be challenging for several reasons.…”