The cortical blood–brain barrier in multiple sclerosis: a gateway to progression?
Despite the historical focus on white matter pathology, it is now increasingly recognised that cortical tissue injury is critical to disease outcome. Cortical pathology occurs from the earliest disease stages, predominates in progressive MS, and correlates with physical and cognitive disability . However, our understanding of disease processes operative in the MS cortex remains poor and, in particular, the contribution of BBB dysfunction has been relatively overlooked. A recent radiological study and pathological findings from our group make steps to address these shortcomings and provide fresh insight into the role of BBB dysfunction in cortical pathology.
Maranzano et al. undertook a retrospective analysis of serial MRI scans from an early MS cohort. Over a 2-year period, 36% of MS patients had cortical gadolinium (Gd)-enhancing lesions, of which 95% were leukocortical . While MRI studies are limited in their ability to detect cortical lesions, these findings...
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The authors declare that they have no competing interests.
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- 7.Stoll G, Kleinschnitz C, Meuth SG et al (2009) Transient widespread blood—brain barrier alterations after cerebral photothrombosis as revealed by gadofluorine M-enhanced magnetic resonance imaging. J Cereb Blood Flow Metab 29:331–341. https://doi.org/10.1038/jcbfm.2008.129 CrossRefPubMedGoogle Scholar
- 9.Cramer SP, Larsson HB (2014) Accurate determination of blood-brain barrier permeability using dynamic contrast-enhanced T1-weighted MRI: a simulation and in vivo study on healthy subjects and multiple sclerosis patients. J Cereb Blood Flow Metab 34:1655–1665. https://doi.org/10.1038/jcbfm.2014.126 CrossRefPubMedPubMedCentralGoogle Scholar