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Different pathological processes for acute white matter lesions in multiple sclerosis.

M Alturkustani1, B Bahakeem, Q Zhang

  • 1King Abdulaziz University, Jeddah, Saudi Arabia. alturkustani.murad@gmail.com.

The Malaysian Journal of Pathology
|August 30, 2020
PubMed
Summary

Acute lesions in multiple sclerosis (MS) show varied pathologies beyond demyelination, including axonal degeneration. This suggests diverse underlying mechanisms contributing to MS lesion development.

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Area of Science:

  • Neuropathology
  • Neuroimmunology
  • Demyelinating Diseases

Background:

  • Multiple sclerosis (MS) presents with diverse clinical, prognostic, and pathological features.
  • Understanding the precise nature of acute MS lesions is crucial for elucidating disease pathogenesis.

Purpose of the Study:

  • To pathologically review acute MS lesions, focusing on axonal injury, myelin loss, and glial response.
  • To differentiate between primary and secondary demyelination in MS lesions.

Main Methods:

  • Retrospective analysis of 8 surgical acute lesion biopsies from patients with clinical MS diagnoses.
  • Pathological examination of white matter lesions for myelin, axons, and cellular reactions.

Main Results:

  • Three distinct pathological patterns were identified in acute MS lesions.
  • Pattern 1 (typical plaques): nearly complete demyelination with axonal preservation/swelling.
  • Pattern 2: mixed demyelination with preserved myelinated axons and axonal swelling.
  • Pattern 3: reduced myelin staining with fragmented axons and apoptotic nuclei, suggesting axonal degeneration without clear demyelination.

Conclusions:

  • Acute MS lesions exhibit pathologies beyond pure demyelination, including axonal degeneration.
  • Lesions can involve primary demyelination alone or in combination with axonal damage.
  • These findings indicate varied pathogenesis underlying acute MS lesions.