Hypoperfusion of the cerebral white matter in multiple sclerosis: possible mechanisms and pathophysiological significance
This work was supported by MS Anders (Amsterdam, The Netherlands).
Jacques De Keyser1,2, Christel Steen2, Jop P Mostert2 and Marcus W Koch2
1Department of Neurology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
2Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Correspondence: Professor Dr J De Keyser, Department of Neurology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels 1090, Belgium. E-mail: email@example.com
Received 2 May 2008; Revised 13 June 2008; Accepted 16 June 2008; Published online 2 July 2008.
Accumulating evidence indicates that there is a decreased perfusion throughout the NAWM in patients with MS. It occurs in both relapsing–remitting and primary progressive MS, strongly suggesting that it represents an integral part of the disease process. Ischemic changes might be involved in the development of a subtype of focal demyelinating lesions (type III lesions). There appears to be a relationship between reduced white matter perfusion and cognitive dysfunction in patients with MS. We provide a hypothetical framework for the reduced perfusion, implicating a key role of astrocyte dysfunction, possibly related to a deficiency in β2-adrenergic receptors resulting in an impaired siphoning and release of K+ in the perivascular spaces. The underlying pathophysiological mechanisms need to be further elucidated as it could ultimately allow us to understand and treat this complex disease better.
http://www.nature.com/jcbfm/journal/v28 ... 0872a.html