| Part IEarly clinical and epidemiological cohorts have shown the distinguished features between oriental MS and western MS in terms of clinical manifestation, the process of disease, the severity, and the response for therapy. Our pathological study also revealed the differences. To evaluate the spectrum of MS and NMO, including demographic data, clinical characteristics, clinical courses, and to evaluate CSF, and serologic studies, We reviewed 226 patients with MS and 32 patients with NMO evaluated at Huashan Hospital between 1994 and 2003. In the past 10 years, the number of MS patients per year tended to increase rapidly, whereas the number of NMO per year was stable. Women were more susceptible to either MS or NMO. Most patients with MS experienced the first attack at the age of 30s and over time the patients usually entered the stage of relapsing-remitting and progression. The average onset age was 32.51+/-10.04. Parenthesis, transitory abnormal sensory feeling such as numbness or "pins and needles" and muscle weakness were the most common initial syndrome, which often involved one extremity at the very beginning and extended to bilateral body. In our series, spinal cord and optic nerves were the most often involved. Oligoclonal bands of CSF were found in 49.2% MS patients and in 21.9% NMO patients. The Clinical, laboratory, and demography features are consisted with the other reports from Asian countries, which confirmed the existence of difference between oriental and western population.Part IIDemyelinating diseases of central nervous system comprise of a group of immune-mediated conditions, among which multiple sclerosis (MS) is a prototype. The pathological hallmark is the demyelinating plaque with reactive glial scar formation and infiltration of immune cells. In this part, we observed postmortem samples obtained from 13 patients with MS or NMO. Serial sections were stained for general histopathology with haematoxylin and eosin (H-E), for myelin with Luxol fast blue and cresylviolet (Kluver-Barrera), and for axons with silver impregnation (Bodian). Furthermore, we made a morphometric study on the cross-sections and demyelinating plaques of the spinal cord. The correlations with disease duration were sought. We found 3 main pathological patterns including diverse demyelinating plaques, coagulate necrosis, and Wallerian degeneration. Destruction of tissue with acute demyelinating plaques were often discovered in patients with an acute, fulminant course, whereas the pathological changes in patients with a chronic course comprised of demyelinating plaques at diverse stages and secondary Wallerian degeneration. The lesions disseminated in the CNS at random. The spinal cord were the most commonly involved, followed by the involvement of brain stem, optic nerves, cerebral hemisphere, and cerebellum. We found a high incidence of spinal cord lesions with extremely heterogeneous pathology as revealed in other structures of CNS. The cervical and upper thoracic cords most frequently had demyelinating plaques in the lateral and dorsal columns and in the dorsal horn with various topographic patterns. In acute patients, coagulate necrosis and edema was predominant in the spinal cord, often resulting in virulence. In chronic patients, the average cross-sectional area correlated negatively with disease duration, but the proportion of demyelinating lesions correlated with disease duration only in the cervical cord. Some distinct features were revealed in other related demyelinating diseases of CNS. The lesions in NMO, which mostly were located along the optic tracts and the spinal cord, were characterized by necrotic myelopathy and cavitations. The infiltrating cells contained quite a lot of neutrophils and plasma cells. In some cases the pathological process diffused in the whole spinal cord or even into the lower medulla. Our data indicate that MS and NMO present heterogeneous pathology. The variety serves to a better explanation for enigmatic clinical manifestation and may reflect different immunological mechanisms.Part IIIDemyelination, axonal damage and inflammation are 3 key factors of histopathology in MS. Previous studies has revealed the damage of axons...
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