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Updated: Jan 14, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Cervical cord atrophy correlates with intracranial lesion burden in tumefactive multiple sclerosis
Albert Aboseif1,2, Caitlin S Jackson-Tarlton1,3, Christopher G Schwarz4
1Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Background:
Spinal cord atrophy associates with motor disability in multiple sclerosis (MS). The influence of intracranial lesion burden (ILB) on spinal cord atrophy requires further investigation. Tumefactive MS (TMS) offers a model for studying the contribution of ILB on spinal cord atrophy.
Objectives:
Determine the relationship between upper cervical cord (UCC) area, ILB, and progressive TMS.
Methods:
Individuals with tumefactive demyelinating disease (TDD) undergoing UCC area analysis (C1-C3) were stratified into three groups based on ILB: single-lesion (SL-TDD), multiple-lesion (ML-TDD), and tumefactive MS (TMS). Descriptive characteristics and UCC area were compared across radiological and clinical phenotypes.
Results:
Of 109 individuals, six (6%) were SL-TDD, 28 (26%) ML-TDD, and 75 (69%) TMS. All seven (6%) with progressive MS met TMS criteria. TMS had more spinal cord (63% vs. 26%; p = 0.003), and lateral tract lesions (54% vs. 14%; p = 0.001), and a higher final EDSS [median 2.5 (IQR 1.5,3.0) vs. 2.0 (0.0,2.0); p = 0.01] than ML-TDD. After excluding individuals with UCC lesions, there was an inverse trend between median C2 area and ILB across groups: SL-TDD, 56.3 mm2 (47.9,69.0); ML-TDD, 53.4 mm2 (37.2,63.2), and TMS, 50.8 mm2 (32.0,64.3); p = 0.08.
Conclusions:
During the course of TMS, early disability may be driven by a single tumefactive lesion while late disability is related to the accrual of intracranial lesions, spinal cord disease, and UCC atrophy. Across the TMS spectrum, there appears to be an inverse relationship between UCC area and ILB, partially independent of UCC lesions which trended towards statistical significance, warranting further investigation.
Insights
Tumefactive Multiple Sclerosis (TMS) is linked to spinal cord atrophy. Higher intracranial lesion burden (ILB) correlates with reduced upper cervical cord (UCC) area in TMS patients, suggesting a potential driver of disability.
Area of Science:
- Neurology
- Neuroimaging
- Demyelinating Diseases
Background:
- Spinal cord atrophy is a known contributor to motor disability in Multiple Sclerosis (MS).
- The impact of intracranial lesion burden (ILB) on spinal cord atrophy remains under-investigated.
- Tumefactive MS (TMS) provides a unique model to explore the relationship between ILB and spinal cord atrophy.
Purpose of the Study:
- To investigate the association between upper cervical cord (UCC) area and intracranial lesion burden (ILB) in patients with tumefactive demyelinating disease (TDD).
- To analyze these relationships across different TDD subtypes, including single-lesion TDD (SL-TDD), multiple-lesion TDD (ML-TDD), and tumefactive MS (TMS).
Main Methods:
- Retrospective analysis of 109 individuals with TDD who underwent UCC area measurement (C1-C3).
- Patients were categorized into SL-TDD, ML-TDD, and TMS groups based on ILB.
- Comparison of descriptive characteristics, UCC area, and lesion distribution between groups.
Main Results:
- TMS patients (69%) exhibited significantly more spinal cord lesions (63% vs. 26%) and lateral tract lesions (54% vs. 14%) compared to ML-TDD patients.
- TMS patients had a higher final Expanded Disability Status Scale (EDSS) score (median 2.5 vs. 2.0).
- An inverse trend was observed between UCC area and ILB across the TDD spectrum, even after excluding UCC lesions (p=0.08).
Conclusions:
- In TMS, early disability may stem from a single lesion, while later disability is associated with accumulated intracranial lesions, spinal cord disease, and UCC atrophy.
- A potential inverse relationship exists between UCC area and ILB across the TMS spectrum, independent of UCC lesions.
- Further research is warranted to confirm the statistical significance and implications of the observed inverse relationship.
