title: Subpial demyelination in the cerebral cortex of multiple sclerosis patients.
abstract: The extent and pattern of demyelination in the cerebral cortex was determined in 78 tissue blocks from the brains of 20 multiple sclerosis (MS) patients and 28 tissue blocks from 7 patients without neurological disease. Tissue blocks from 4 predetermined areas (cingulate gyrus, frontal, parietal, and temporal lobe) were studied, irrespective of macroscopically evident MS plaques. All tissue blocks contained cerebral cortex and periventricular and/or subcortical white matter. One hundred and nine demyelinating lesions were detected in the cerebral cortex, of which 92 (84.4%) were purely intracortical and 17 (15.6%) were lesions extending through both white and gray matter areas. In 5 of the 20 MS brains, subpial demyelination was extensive in the 4 widely spaced cortical areas studied, thus considered to represent a general cortical subpial demyelination. The percentage of demyelinated area was significantly higher in the cerebral cortex (mean 26.5%, median 14.1%) than in white matter (mean 6.5%, median 0%) (p = 0.001). Both gray and white matter demyelination was more prominent in the cingulate gyrus than in the other areas examined (p < 0.05). These results indicate that the cerebral cortex is likely to be a predilection site for MS lesions and identify general cortical subpial demyelination as a distinct pattern occurring in a significant subpopulation of MS patients.
authors.affiliation: Department of Neurology, Haukeland Hospital, Bergen, Norway. l.boe@vumc.nl
authors.forename: Lars
authors.initials: L
authors.lastname: Bø
authors.forename: Christian A
authors.initials: CA
authors.lastname: Vedeler
authors.forename: Harald I
authors.initials: HI
authors.lastname: Nyland
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Trapp
authors.forename: Sverre J
authors.initials: SJ
authors.lastname: Mørk
mesh_terms: D000328:Adult; D000368:Aged; D001369:Axons / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D006179:Gyrus Cinguli / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000503:physiopathology; D004676:Myelin Basic Protein / Q000378:metabolism; D018991:Myelin Proteolipid Protein / Q000378:metabolism; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D010296:Parietal Lobe / Q000473:pathology / Q000503:physiopathology; D010841:Pia Mater / Q000473:pathology*; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology
chemical_list: D004676:Myelin Basic Protein; D018991:Myelin Proteolipid Protein