Brain, Vol. 122, No. 1, 17-26,
January 1999
© 1999 Oxford University Press
Cortical lesions in multiple sclerosis
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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