Can Gray Matter Lesions Really Cause Problems?

[Sarahsmom46]

The MS neurologist that I saw recently for my 2nd opinion told me that he suspected that there were problems going on in the gray matter in my case that would help explain some of my symptoms and exam findings.  He also mentioned that we do not have good technology for imaging the gray matter.  

Question:  Is this true about the gray matter being difficult to image?   Also, how does a lesion in the gray matter affect the nervous system?  I know these must be very elementary questions, but I can't wrap my "gray matter" around this idea.  :-)

Julie

[Sarahsmom46]

Thanks you guys for helping me with this question.  I've deferred to Quix's postings to help understand it better.  Thanks again.

Julie

[Lulu54]

Q- that may be more succinct but I'm rereading it for the umpteenth time to truly absorb what it means...... I may actually be understanding something here.   :-)  

so where can we buy a copy of the epic Lesions, Lesions and More Lesions? :-)

[Quixotic1]

or....read my new Epic Discourse!  :))

Thanks, Lulu.  That probably is more succinct than mine.

Q

[Lulu54]

Julie - I went looking for an answer and found these:

ABSTRACT
Although multiple sclerosis (MS) has been considered a white matter disease, MS lesions are known to occur in grey matter. Recent immunohistochemical studies have demonstrated extensive grey matter demyelination in chronic MS. The most common lesion type consists of purely cortical lesions extending inward from the surface of the brain, this lesion subgroup is grossly underestimated by standard histochemical myelin staining methods. Some MS patients have subpial demyelination in all cortical areas of the brain; this pattern has been termed ''general cortical subpial demyelination''. Extensive cortical demyelination is associated with the progressive phases of disease, as less cortical demyelination has been detected in relapsing-remitting MS. The pathology of grey matter lesions differs from that of white matter lesions; grey matter lesions are less inflammatory, with less macrophage and lymphocyte infiltration. In purely cortical lesions there is no significant increase in lymphocytes compared with non-demyelinated adjacent cortical areas in MS patients or cerebral cortex in control patients. Significant axonal transection and neuronal loss have been demonstrated in grey matter MS lesions. Current magnetic resonance imaging (MRI) methods are not sensitive for purely cortical MS lesions. The clinical significance of cortical MS lesions may not be characterised until more sensitive MRI methods are developed.
full text at
http://www3.interscience.wiley.com/journal/118578341/abstract?CRETRY=1&SRETRY=0

From the little bit I read this evening in looking at your question, the MRI doesn't read the lesions in gray matter like white matter, as your doctor already said.  The white matter lesions most predominantly are linked to RRMS, if I read correctly.  So where are the PPMS lesions?  Are they hiding in the gray matter?  They can't image the gray  the same way, but in autoposy they can get answers and link lesions found there to MS symptoms.

Another couple articles  that might be of help -

http://brain.oxfordjournals.org/cgi/content/full/126/8/1719


http://msj.sagepub.com/cgi/content/abstract/1352458508096876v1

[Quixotic1]

This post prompted me to get off my duff and write a blurb.  Please see "Lesions, Lesions and more Lesions!"

Quix