Different pathological processes for acute white matter lesions in multiple sclerosis
- Author:
Murad Alturkustani
1
Author Information
1. King Abdulaziz University, Jeddah, Saudi Arabia
- Collective Name:Basem Bahakeem; Qi Zhang; Lee-Cyn Ang
- Publication Type:Journal Article
- Keywords:
Multiple sclerosis;
demyelination;
white matter;
axonal degeneration;
myelin
- From:The Malaysian Journal of Pathology
2020;42(2):187-194
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Multiple sclerosis (MS) has variable clinical presentations, prognoses, pathogeneses,
and pathological patterns. We conducted a pathological review of acute MS-associated lesions that
focused on the degree of axonal injury, myelin loss, and glial reaction to determine whether the
observed demyelination was of the primary or secondary type. Materials and Methods: After searching
the records for a 15-year period at the London Health Sciences Centre Pathology Department, we
identified 8 cases of surgical acute lesion biopsies in which clinical MS diagnoses were made before
or after the biopsy. Results: The white matter pathologies in these cases could be sorted into 3
morphological patterns. The first pattern, which represents typical demyelinated plaques, was observed
in 4 cases and was characterised by nearly complete demyelination accompanied by variable degrees
of axon preservation and axonal swelling. The second pattern was observed in 3 cases and was
characterised by demyelinating lesions containing variable numbers of myelinated axons mixed with
a few demyelinated axons and variable numbers of axonal swellings. The myelinated axons ranged
from scattered fibres to bands of variable thickness, and the demyelination was a mixture of primary
and secondary demyelination. The third pattern was observed in 1 case and was characterised by
well-demarcated areas of reduced myelin staining and numerous apoptotic nuclei. Axonal staining
revealed many fragmented axons with reduced myelin staining but no definitely demyelinated axons.
Conclusion: This report shows that the predominant pathology underlying acute MS-related lesions
is not limited to demyelination but can include axonal degeneration alone or in combination with
primary demyelination which reflect different pathogenesis for these acute lesions.
- Full text:5.2020my01060.pdf
