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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