Extensive proliferation of peripheral type myelin in necrotic spinal cord lesions of multiple sclerosis

Peripheral type "remyelination" in the spinal cord was investigated in a 34-year-old woman with relapsing multiple sclerosis (MS) over 7 years following her initial presentation with myelopathy. Confined to the large necrotizing cord lesions involving the gray matter, there was prominent proliferation of peripheral type myelin, measuring up to one-third of the cross-sectional field of the cord. These nerve bundles with peripheral type myelin, which was devoid of glial fibrillary acidic protein immunoreactivity, consisted of relatively monotonous, small-caliber nerve fibers arranged in parallel along the long axis of the cord. The ratio of the myelin thickness to axonal diameter was not as small as that of the ordinary remyelination. Co-existing abundant neuroma formation indicated exuberant regenerative activity of the peripheral nerves. These findings suggest that the peripheral nerve fibers with their axons originating from nerve roots may enter the necrotic MS cord lesions in such a way as to manifest in spinal cord trauma. Relatively frequent occurrence of this extensive proliferation of peripheral type myelin in Japanese MS subjects appears to be related to the severity of tissue destruction experienced in Japanese as compared with that of occidental MS.