Journal of Neuropathology and Experimental
Neurology: Vol. 60, No. 12, pp. 1208–1218.
Inge Huitinga, Corline J.A. De Groot,
Paul Van der Valk, Wouter Kamphorst, Fred J.H. Tilders, Dick F. Swaab
Graduate School for Neurosciences,
Netherlands Institute for Brain Research (IH, DFS), Amsterdam;
MS Centre for Research and Care
(MSCRC), Vrije Universiteit Medical Centre, Department of Pathology, Division
of Neuropathology (CJADG, PVdV, WK), Amsterdam;
Graduate School for Neurosciences,
Department of Pharmacology, Vrije Universiteit Medical Centre (FJHT), Amsterdam,
The Netherlands.
Abstract
Demyelinating lesions of fiber bundles
in and adjacent to the hypothalamus (i.e. the fornix, anterior commissure,
internal capsule, and optic system) may be the basis for autonomic and
endocrine alterations in multiple sclerosis (MS) patients.
Therefore we investigated the presence
and immunological activity of lesions in hypothalamic fiber bundles of
17 MS patients and 14 controls.
In the MS group, 16 of 17 patients
showed demyelinated lesions.
The incidence of active lesions was
high (60%) and outnumbered chronic inactive lesions in the internal capsule
(p = 0.005).
In 4 of 17 MS patients, axonal damage
was observed and in 3 of 17 MS patients grey matter lesions were apparent.
Duration of MS was inversely related
to the active hypothalamic MS lesion score (r = 0.72, p = 0.001).
Since comparison of hypothalamic
lesions with MS lesions in other areas of the brain in the same patients
(n = 7) showed a great similarity both as stage and appearance was concerned,
this negative relation in all likelihood reflects the clinical consequences
of high disease activity throughout the whole brain.
In controls no demyelinating lesions
were seen but in 11 control cases HLA expression was observed that was
lower than that present in MS patients (p = 0.02).
In the median eminence region that
lacks a blood-brain barrier, all controls showed a strong HLA expression
around the blood vessels.
We conclude that systematic pathological
investigation of the hypothalamus in MS patients reveals an unexpected
high incidence of active lesions that may impact on hypothalamic functioning.
© Copyright by American Association
of Neuropathologists, Inc. 2001