Grey Matter lesions hits from the meninges and hits in the white matter

Haider L, Zrzavy T, Hametner S, Höftberger R, Bagnato F, Grabner G, Trattnig S, Pfeifenbring S, Brück W, Lassmann H. The topograpy of demyelination and neurodegeneration in the multiple sclerosis brain. Brain. 2016 Feb 8. pii: awv398. [Epub ahead of print]

Multiple sclerosis is a chronic inflammatory disease with primary demyelination and neurodegeneration in the central nervous system. In our study we analysed demyelination and neurodegeneration in a large series of multiple sclerosis brains and provide a map that displays the frequency of different brain areas to be affected by these processes. Demyelination in the cerebral cortex was related to inflammatory infiltrates in the meninges, which was pronounced in invaginations of the brain surface (sulci) and possibly promoted by low flow of the cerebrospinal fluid in these areas. Focal demyelinated lesions in the white matter occurred at sites with high venous density and additionally accumulated in watershed areas of low arterial blood supply. Two different patterns of neurodegeneration in the cortex were identified: oxidative injury of cortical neurons and retrograde neurodegeneration due to axonal injury in the white matter. While oxidative injury was related to the inflammatory process in the meninges and pronounced in actively demyelinating cortical lesions, retrograde degeneration was mainly related to demyelinated lesions and axonal loss in the white matter. Our data show that accumulation of lesions and neurodegeneration in the multiple sclerosis brain does not affect all brain regions equally and provides the pathological basis for the selection of brain areas for monitoring regional injury and atrophy development in future magnetic resonance imaging studies.

In our study they analysed predilection sites of demyelination and neurodegeneration and how these relate to arterial and venous anatomy and inflammation or demyelination in multiple sclerosis.

Where are the lesions located?

Around the ventricles and around the cortex and in the  sulci.

The highest frequency of lesions was seen in the periventricular white matter, but in addition the lesions accumulated in a fan-shaped pattern expanding from the periventricular region towards the deep and juxta-cortical white matter

Areas with a high venous density are likely to harbour demyelinated white matter lesions, but not all brain areas with high venous density are equally affected. This is because the damaging cells enter the CNS via venules/vein. It is not because of blocked veins

In this study they distinguished between two different patterns of neurodegeneration. The first was oxidative injury and is a problem leading to energy problems for nerves.The second pattern of neuronal pathology represented retrograde neurodegeneration. 

When axons are transected, their associated neuronal cell bodies develop problems.. So demyelination and damage in the axons and nerve results in damage to their nerve cell bodies and nerve damage in the grey matter

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  • I am not an expert when it come to "fluidics". But has anyone ever done a fluid simulation of a brain?

    On first sight I would say that the 100% lesion marks look like typical erosion areas when compared to mechanics.

    A simulatiom should be an easy task as most of the data is availible and in most cases interchangeable with siumulation programs.

  • So the discovery that the brain is not immune privileged that deep veins um the brain communicates with the immune system can determine that the main route of entry of immune cells is through these veins and not only and mainly by the BBB?

    And another question: why then places with these certain veins are targets of demyelinating lesions, and not all the other regions where there may be such venules/veins that allow this communication?

  • How come … I wonder … that these Ectrims events (and similar MS events) always are placed in very attractive places with tourist appeal.

    The program and the places /cities, where the yearly Ectrims conference is presented on the Ectrims web site, is presented as attractive Tourist places with clear Tourist appeal and very attractive Pictures – almost like a Tourist brochure

    A snapshot of the locations for last years Ectrims events …

    2014: Boston
    2015: Barcelona
    2016 Workshop: Florence
    2016 :London

    I bet that tourist events are embedded into the workshop in Florence.

    I REALLY Hope these workshops and events are of some use for pwMS and not to much of reward system for neruo docotors and others who participate.

    If I would had the Money and Health, I would like to visite these very nice places,

    AND YES you probably right: I guess I am just jelous



    • Remember at the conferences, particularly big ones like ECTRIMS/ACTRIMS a lot of people will be attending, so you need a lot of hotel beds, which will obviously correlate with the most popular tourist destinations. That's not to say that some are very enjoyable due to their location!

    • I have organised continuing education conferences for a different profession and it's normal to want to organise a conference where people will want to go…

  • MD, your comments are wrong:
    a) You say "but not all brain areas with high venous density are equally affected."
    but the article refers to the WHOLE brain: "Our data show that accumulation of lesions and neurodegeneration in the multiple sclerosis brain does not affect all brain regions equally…"

    The article DOES stress the factor of venous density as a selection guide of areas in danger. Your comment misinterprets the article in order to remove the emphasis from the venous system.

    b) You say: "This is because the damaging cells enter the CNS via venules/vein. It is not because of blocked veins"

    You get goosebumps whenever veins are mentioned and take conjectures for granted. There is NO PROOF yet that cells of some kind damage healthy brain tissue. What is known is that cells of many kinds are found in damaged areas. Officially MS is still of unknown aetiology.

    • (a) I didn't say this it came from the paper
      (b) Yes I added the bit about not because of block veins band I accept that there is some conjecture on my part

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