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Cortical lesions in multiple sclerosis.

D Kidd1, F Barkhof, R McConnell

  • 1The National Hospital for Neurology and Neurosurgery, London, UK.

Brain : a Journal of Neurology
|March 2, 1999
PubMed
Summary
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Small cortical lesions are common in multiple sclerosis (MS). These MS lesions, often near cortical veins, are frequently missed by MRI scans, indicating a need for improved detection methods.

Area of Science:

  • Neurology
  • Neuroimaging
  • Pathology

Background:

  • Multiple sclerosis (MS) lesions can affect the cerebral cortex, but their prevalence and distribution are not well-documented.
  • Previous research has limited data on cortical lesion characteristics in MS.

Purpose of the Study:

  • To assess the prevalence and distribution of multiple sclerosis lesions in the cerebral cortex.
  • To investigate the relationship between cortical lesions and cortical veins.
  • To compare MRI findings with neuropathological analysis for lesion detection.

Main Methods:

  • Serial magnetic resonance imaging (MRI) with and without gadolinium contrast.
  • Post-mortem neuropathological examination of brain tissue.
  • Analysis of 12 cases to identify and categorize cortical lesions.

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Main Results:

  • Gadolinium-enhanced MRI increased cortical lesion detection by 140%, identifying 26% of active lesions near the cortex.
  • Post-mortem analysis revealed MRI under-reported cortical lesions, especially those within the cortex.
  • 478 cortical lesions were identified in 12 cases, with 372 involving the subcortical white matter. Most lesions were associated with cortical veins.

Conclusions:

  • Small cortical lesions are common in multiple sclerosis and are often under-detected by MRI.
  • Lesion development is linked to the cortical venous system, explaining their frequent involvement of underlying white matter.