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Brain, Vol. 122, No. 1, 17-26, January 1999
© 1999 Oxford University Press

Cortical lesions in multiple sclerosis

D. Kidd1, F. Barkhof2, R. McConnell3, P. R. Algra2, I. V. Allen3 and T. Revesz1

1 The National Hospital for Neurology and Neurosurgery, London, UK, 2 Department of Radiology, Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands and 3 Neuropathology Department, the Queen's University of Belfast, Northern Ireland

Correspondence to: Dr Tamas Revesz, Neuropathology Department, Institute of Neurology, Queen Square, London WC1N 3BG, UK

Although previous studies have shown that the lesions of multiple sclerosis may involve the cerebral cortex, there is little published research on the prevalence and distribution of such lesions. Using neuropathological techniques and MRI, a series of studies has been undertaken in order to assess this, in particular to identify their relationship to cortical veins. A serial MRI study showed that the use of gadolinium proffered an increase in cortical lesion detection of 140% and showed that 26% of active lesions arose within or adjacent to the cortex. In a post-mortem study, MRI under-reported lesions subsequently analysed neuropathologically, particularly those arising within the cortex. In a further 12 cases examined, 478 cortical lesions were identified, of which 372 also involved the subcortical white matter. Seven different lesion types were identified; the majority arose within the territory of the principal cortical veins, whilst the remaining quarter arose within the territory of the small branch or superficial veins. Small cortical lesions are common in multiple sclerosis and are under-reported by MRI. Investigation of the cortical venous supply shows how such lesions may arise, and why the majority also involve the underlying white matter.

multiple sclerosis; cortical lesions; neuropathology; MRI


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Gray and white matter volume changes in early RRMS: A 2-year longitudinal study
Neurology, March 22, 2005; 64(6): 1001 - 1007.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
J. J. G. Geurts, L. Bo, P. J. W. Pouwels, J. A. Castelijns, C. H. Polman, and F. Barkhof
Cortical Lesions in Multiple Sclerosis: Combined Postmortem MR Imaging and Histopathology
AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 572 - 577.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
J.-P. Ranjeva, B. Audoin, M. Van Au Duong, D. Ibarrola, S. Confort-Gouny, I. Malikova, E. Soulier, P. Viout, A. Ali-Cherif, J. Pelletier, et al.
Local Tissue Damage Assessed with Statistical Mapping Analysis of Brain Magnetization Transfer Ratio: Relationship with Functional Status of Patients in the Earliest Stage of Multiple Sclerosis
AJNR Am. J. Neuroradiol., January 1, 2005; 26(1): 119 - 127.
[Abstract] [Full Text] [PDF]

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 Mult SclerHome page
M R Haupts, S Daum, G Ahle, B Holinka, and W Gehlen
Transcranial magnetic stimulation as a provocation for epileptic seizures in multiple sclerosis
Multiple Sclerosis, August 1, 2004; 10(4): 475 - 476.
[Abstract] [PDF]

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 NeurologyHome page
M. P. Amato, M. L. Bartolozzi, V. Zipoli, E. Portaccio, M. Mortilla, L. Guidi, G. Siracusa, S. Sorbi, A. Federico, and N. De Stefano
Neocortical volume decrease in relapsing-remitting MS patients with mild cognitive impairment
Neurology, July 13, 2004; 63(1): 89 - 93.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
G R Davies, L Ramio-Torrenta, A Hadjiprocopis, D T Chard, C M B Griffin, W Rashid, G J Barker, R Kapoor, A J Thompson, and D H Miller
Evidence for grey matter MTR abnormality in minimally disabled patients with early relapsing-remitting multiple sclerosis
J. Neurol. Neurosurg. Psychiatry, July 1, 2004; 75(7): 998 - 1002.
[Abstract] [Full Text] [PDF]

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 Mult SclerHome page
C. Lucchinetti and W. Bruck
The pathology of primary progressive multiple sclerosis
Multiple Sclerosis, June 1, 2004; 10(1_suppl): S23 - S30.
[Abstract] [PDF]

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 BrainHome page
C. M. Dalton, D. T. Chard, G. R. Davies, K. A. Miszkiel, D. R. Altmann, K. Fernando, G. T. Plant, A. J. Thompson, and D. H. Miller
Early development of multiple sclerosis is associated with progressive grey matter atrophy in patients presenting with clinically isolated syndromes
Brain, May 1, 2004; 127(5): 1101 - 1107.
[Abstract] [Full Text] [PDF]

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 Mult SclerHome page
C. Lucchinetti and W. Bruck
The pathology of primary progressive multiple sclerosis
Multiple Sclerosis, May 1, 2004; 10(3_suppl): S23 - S30.
[Abstract] [PDF]

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 NeurologyHome page
A. Feinstein, P. Roy, N. Lobaugh, K. Feinstein, P. O'Connor, and S. Black
Structural brain abnormalities in multiple sclerosis patients with major depression
Neurology, February 24, 2004; 62(4): 586 - 590.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
M. C. Tartaglia, S. Narayanan, S. J. Francis, A. C. Santos, N. De Stefano, Y. Lapierre, and D. L. Arnold
The Relationship Between Diffuse Axonal Damage and Fatigue in Multiple Sclerosis
Arch Neurol, February 1, 2004; 61(2): 201 - 207.
[Abstract] [Full Text] [PDF]

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A Traboulsee, J Dehmeshki, K. R Peters, C M Griffin, P A Brex, N Silver, O Ciccarrelli, D T Chard, G J Barker, A J Thompson, et al.
Disability in multiple sclerosis is related to normal appearing brain tissue MTR histogram abnormalities
Multiple Sclerosis, December 1, 2003; 9(6): 566 - 573.
[Abstract] [PDF]

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 Mult SclerHome page
L Bo, C A Vedeler, H Nyland, B D Trapp, and S J Mork
Intracortical multiple sclerosis lesions are not associated with increased lymphocyte infiltration
Multiple Sclerosis, August 1, 2003; 9(4): 323 - 331.
[Abstract] [PDF]

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 BrainHome page
M. Sailer, B. Fischl, D. Salat, C. Tempelmann, M. A. Schonfeld, E. Busa, N. Bodammer, H.-J. Heinze, and A. Dale
Focal thinning of the cerebral cortex in multiple sclerosis
Brain, August 1, 2003; 126(8): 1734 - 1744.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
M Zarei, S Chandran, A Compston, and J Hodges
Cognitive presentation of multiple sclerosis: evidence for a cortical variant
J. Neurol. Neurosurg. Psychiatry, July 1, 2003; 74(7): 872 - 877.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
M. Wylezinska, A. Cifelli, P. Jezzard, J. Palace, M. Alecci, and P. M. Matthews
Thalamic neurodegeneration in relapsing-remitting multiple sclerosis
Neurology, June 24, 2003; 60(12): 1949 - 1954.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
N. De Stefano, P. M. Matthews, M. Filippi, F. Agosta, M. De Luca, M. L. Bartolozzi, L. Guidi, A. Ghezzi, E. Montanari, A. Cifelli, et al.
Evidence of early cortical atrophy in MS: Relevance to white matter changes and disability
Neurology, April 8, 2003; 60(7): 1157 - 1162.
[Abstract] [Full Text] [PDF]

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B. Turner, X. Lin, G. Calmon, N. Roberts, and L. D Blumhardt
C erebral atrophy and disability in relapsing-remitting and secondary progressive multiple sclerosis over four years
Multiple Sclerosis, February 1, 2003; 9(1): 21 - 27.
[Abstract] [PDF]

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 BrainHome page
D. T. Chard, C. M. Griffin, M. A. McLean, P. Kapeller, R. Kapoor, A. J. Thompson, and D. H. Miller
Brain metabolite changes in cortical grey and normal-appearing white matter in clinically early relapsing-remitting multiple sclerosis
Brain, October 1, 2002; 125(10): 2342 - 2352.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
M. Rovaris, M. Bozzali, G. Iannucci, A. Ghezzi, D. Caputo, E. Montanari, A. Bertolotto, R. Bergamaschi, R. Capra, G. L. Mancardi, et al.
Assessment of Normal-Appearing White and Gray Matter in Patients With Primary Progressive Multiple Sclerosis: A Diffusion-Tensor Magnetic Resonance Imaging Study
Arch Neurol, September 1, 2002; 59(9): 1406 - 1412.
[Abstract] [Full Text] [PDF]

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D. H. Miller, F. Barkhof, J. A. Frank, G. J. M. Parker, and A. J. Thompson
Measurement of atrophy in multiple sclerosis: pathological basis, methodological aspects and clinical relevance
Brain, August 1, 2002; 125(8): 1676 - 1695.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
M. Bozzali, M. Cercignani, M. P. Sormani, G. Comi, and M. Filippi
Quantification of Brain Gray Matter Damage in Different MS Phenotypes by Use of Diffusion Tensor MR Imaging
AJNR Am. J. Neuroradiol., June 1, 2002; 23(6): 985 - 988.
[Abstract] [Full Text] [PDF]

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A Cifelli and P M Matthews
Cerebral plasticity in multiple sclerosis: insights from fMRI
Multiple Sclerosis, June 1, 2002; 8(3): 193 - 199.
[Abstract] [PDF]

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 Mult SclerHome page
P Kapeller, P A Brex, D Chard, C Dalton, C M Griffin, M A McLean, G J. Parker, A J Thompson, and D H Miller
Quantitative 1H MRS imaging 14 years after presenting with a clinically isolated syndrome suggestive of multiple sclerosis
Multiple Sclerosis, June 1, 2002; 8(3): 207 - 210.
[Abstract] [PDF]

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 Mult SclerHome page
C M Griffin, J Dehmeshki, D T Chard, G J. Parker, G J Barker, A J Thompson, and D H Miller
T1 histograms of normal-appearing brain tissue are abnormal in early relapsing-remitting multiple sclerosis
Multiple Sclerosis, June 1, 2002; 8(3): 211 - 216.
[Abstract] [PDF]

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 NeurologyHome page
M. Filippi and R. I. Grossman
MRI techniques to monitor MS evolution: The present and the future
Neurology, April 23, 2002; 58(8): 1147 - 1153.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
M E Morris, C Cantwell, L Vowels, and K Dodd
Changes in gait and fatigue from morning to afternoon in people with multiple sclerosis
J. Neurol. Neurosurg. Psychiatry, March 1, 2002; 72(3): 361 - 365.
[Abstract] [Full Text] [PDF]

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 BrainHome page
D. T. Chard, C. M. Griffin, G. J. M. Parker, R. Kapoor, A. J. Thompson, and D. H. Miller
Brain atrophy in clinically early relapsing-remitting multiple sclerosis
Brain, February 1, 2002; 125(2): 327 - 337.
[Abstract] [Full Text] [PDF]


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