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Leukoaraiosis and MS lesions appear in the same places
Posted: Sun Feb 14, 2016 4:43 pm
by frodo
From the new article:
https://brain.oxfordjournals.org/conten ... ain.awv398
They explain that in the aging patients, damage is produced not only by the MS underlying condition, but also by the normal leukoaraiosis process
"Thus, periventricular white matter damage in patients with progressive multiple sclerosis is not only due to axonal transection in plaques, but also to age-related injury"
They also say that both kind of lesions are similar:
"It is currently not possible to differentiate the contribution of each of these mechanisms to the global extent of damage in the periventricular normal-appearing white matter. It has, however, to be noted that the white matter injury in leukoarayosis also occurs at sites of low physiological blood perfusion in the brain and appears to be driven by age-related pathological changes in the long penetrating arteries providing the blood supply in these areas"
The article is open and shows several pictures showing that lesions appear in areas with high venous density.
Re: Leukoaraiosis and MS lesions appear in the same places
Posted: Tue Feb 16, 2016 8:33 am
by 1eye
This article contains up-to-date thinking about the pathogenesis of MS. A number of statements are made, but what appears significant to me is that there is nothing that points to progressive MS being a different disease.
We and others recently proposed that microglia activation, production of reactive oxygen species and oxidative damage are key mechanisms driving demyelination and neurodegeneration, particularly in the progressive disease stage (Haider et al., 2011; Fischer et al., 2013). In addition, mitochondrial injury (Mahad et al., 2008; Campbell et al., 2011) may further propagate oxygen radical production (Murphy, 2009) and amplify demyelination and neurodegeneration by energy deficiency through histotoxic hypoxia (Trapp and Stys, 2009; Witte et al., 2010). With disease progression, the intensity of the inflammatory response declines, but oxidative injury and mitochondrial damage are aggravated by additional factors related to ageing of the patients and to the accumulation of disease and lesion burden (Mahad et al., 2015).
If this concept is valid, besides density of veins and meningeal inflammatory infiltrates also arterial anatomy of the brain should influence the topographical distribution of demyelinated lesions and neurodegeneration within the CNS due to varying basic levels of oxygen tension (Desai et al., 2014). In our study we analysed predilection sites of demyelination and neurodegeneration and how these relate to arterial and venous anatomy and inflammation or demyelination in multiple sclerosis.
So it may be that the drastic variations not only in symptomatology, but in the course and duration of the disease may be explainable as well, by differences in
arterial and venous anatomy.
...anatomy of the brain should influence the topographical distribution of demyelinated lesions and neurodegeneration within the CNS.
Re: Leukoaraiosis and MS lesions appear in the same places
Posted: Wed Feb 17, 2016 2:46 pm
by ThisIsMA
Hi Frodo,
That is a great article. Thanks for posting it. More evidence of venous influence on MS. Its particularly amazing that they say its not currently possible to distinguish between MS lesions and lesions caused by aging-related hypoxic injury (if I'm paraphrasing that correctly). This adds to my feeling that MS is just a grab bag of symptoms label, that could be caused by a variety of things.
Makes me wonder if a big whiplash incident I had prior to diagnosis might have been what reduced my brain perfusion to the degree that resulted in lesions that got labeled as MS. I'm just speculating of course.
Thanks for this additional piece of the puzzle.
M.A.
Re: Leukoaraiosis and MS lesions appear in the same places
Posted: Fri Mar 04, 2016 1:09 pm
by 1eye
Sounds like an easy study to do: just tabulate the number of cases of whiplash that have MS post-accident. I am awfully fearful of my wife's friend who was just rear-ended in a massive collision that totaled both cars. She was sent home to await her fate. It may take a while but something bad is coming. Who should she go too?