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Updated: May 9, 2026

Comprehensive Autopsy Program for Individuals with Multiple Sclerosis

Comprehensive Autopsy Program for Individuals with Multiple Sclerosis

Published on: July 19, 2019

Pathology of multiple sclerosis: where do we stand?

Bogdan F Gh Popescu¹, Istvan Pirko, Claudia F Lucchinetti

¹Department of Neurology, Mayo Clinic College of Medicine, 200 First St Southwest, Rochester, MN 55905, USA.

Continuum (Minneapolis, Minn.)

|August 7, 2013

Summary

Multiple sclerosis (MS) pathology is diverse, with distinct immunopathology patterns. Early cortical demyelination, driven by meningeal inflammation, is a key feature in MS pathogenesis.

Area of Science:

Neuropathology
Neuroimmunology
Inflammatory Demyelinating Diseases

Background:

Multiple sclerosis (MS) is characterized by focal demyelinated plaques in the central nervous system (CNS).
Pathologic heterogeneity exists in active MS lesions, with four major immunopathology patterns identified.
Understanding these patterns is crucial for elucidating mechanisms of demyelination.

Observation:

MS lesions exhibit significant pathologic heterogeneity, suggesting varied injury targets and demyelination mechanisms.
Recent studies indicate the subarachnoid space and cortex as potential early sites of MS pathology.
Inflammatory cortical demyelination and meningeal inflammation are increasingly recognized as early events in MS.

Findings:

Active MS lesions display four distinct immunopathology patterns, highlighting disease heterogeneity.

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Cortical demyelination, driven by meningeal inflammation, appears to be an early pathogenic event in MS.

Neurodegeneration and gliosis accompany demyelination in MS plaques.

Implications:

Developing biomarkers to identify the four MS immunopatterns in nonbiopsied patients is essential.
Imaging techniques to detect early inflammatory cortical demyelination are needed for better pathogenesis understanding.
Therapeutic strategies targeting meningeal inflammation and cortical involvement may impact MS progression.