what is confluent demyelination?

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what is confluent demyelination?

Postby frodo » Sun Oct 20, 2013 3:54 pm

I was looking for perivenous demyelination articles, assuming they would be related to MS, and I have found this one:


Source: http://www.ncbi.nlm.nih.gov/pubmed/20129932

Distinction between acute disseminated encephalomyelitis and acute multiple sclerosis is often clinically difficult. Perivenous demyelination is the pathological hallmark of acute disseminated encephalomyelitis, whereas confluent demyelination is the hallmark of acute multiple sclerosis. We investigated whether perivenous demyelination versus confluent demyelination distinguishes acute disseminated encephalomyelitis from multiple sclerosis. Patients with perivenous demyelination (n = 13; median age 43 years, range 5-67) on brain biopsy and/or autopsy, ascertained retrospectively, were compared with a cohort with confluent demyelination only (n = 91; 84% multiple sclerosis, 16% isolated syndrome at follow-up; median age 39 years, range 10-69).


They say that perivenous demyelination is a hallmark for ADEM instead of MS, and that MS presents something called "confluent demyelination". What is that?
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Re: what is confluent demyelination?

Postby Cece » Sun Oct 20, 2013 6:12 pm

http://neuropathology-web.org/chapter6/chapter6aMs.html
Schilder's disease is an acute relentlessly progressive form of MS seen most commonly in children and young adults. It causes extensive confluent demyelination instead of multiple focal lesions.

Huh. Here's what it's not: confluent demyelination is not multiple focal lesions. There's an MRI image of the brain in Shilder's disease and instead of the familiar usual MS lesions, the white just keep going.

frodo wrote:They say that perivenous demyelination is a hallmark for ADEM instead of MS, and that MS presents something called "confluent demyelination". What is that?

I think it's not saying that all MS that presents with confluent demyelination, but "acute MS" does.

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Re: what is confluent demyelination?

Postby ttucker3 » Tue Oct 22, 2013 11:29 am

I suspect it refers to the joining point of two or more veins or arteries which results in localized regions of blood flow turbulence. At this point endothelial cells may be weakened giving rise to localized de-myelination. Similar effects occur on the arterial side near confluences, giving rise to arteriosclerosis inflammation at these points.
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