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November 2008

Persistence of Immunopathological and Radiological Traits in Multiple Sclerosis

Author Affiliations

Author Affiliations: Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany (Drs König, Metz, and Brück); Division of Molecular Neuroimmunology, Departments of Neurology, University of Heidelberg, Heidelberg, Germany (Dr Wildemann), Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Drs Nessler, Zhou, Hemmer, Hartung, and Kieseier), and Klinikum rechts der Isar, Technische Universität München, Munich, Germany (Dr Hemmer); and Institute for Multiple Sclerosis Research, University Medical Center Göttingen and Gemeinnützige Hertie-Stiftung, Göttingen (Dr Brück).

Arch Neurol. 2008;65(11):1527-1532. doi:10.1001/archneur.65.11.1527

Background  Multiple sclerosis (MS) is a heterogeneous autoimmune disease of the central nervous system. The identification of 4 different immunopathological subtypes of MS raises the question of whether these subtypes represent different patient subgroups that can be distinguished according to their leading mechanism of myelin destruction or whether this is a stage-dependent process in the development of lesions in a given patient.

Objective  To document intraindividual immunopathological and radiological homogeneity of 2 different lesions in a single patient with relapsing-remitting MS over time.

Design  Case report.

Setting  A neuropathological referral center for inflammatory demyelinating diseases of the central nervous system.

Patient  A 49-year-old woman with clinically definite relapsing-remitting MS.

Main Outcome Measures  Radiological and immunopathological analysis of MS lesions.

Results  Identical pathological findings in 2 different MS lesions separated by more than 2 years were identified. These lesions displayed similar and distinct radiological features on cranial imaging.

Conclusions  In this patient we were able to show the same antibody/complement-mediated lesion pathological findings with compatible identical ring enhancement on T1-weighted magnetic resonance images and hypointense rims on T2-weighted images after an interval of 26 months. Our observations support the concept of intraindividual homogeneity of a given immunopathological MS subtype.