fig4

Figure 4. Defining a cohort of cortical High grey matter lesion MS. Nine progressive MS cases with the greatest relative area of subpial cortical demyelination were labelled as Cortical High GML MS and the remaining cases as Cortical Low GML MS (A). Cortical High GML MS had a greater area of demyelinated deep grey matter and hippocampus (B), but unchanged white matter lesion areas (C). The density of CD68+ microglia/macrophages was increased in both normal appearing GM (NGM) and GML of cortical High GML MS (D) but was only different in the underlying normal appearing WM (NWM) (E). Semi-quantitative evaluation of meningeal inflammation revealed cortical High GML MS to have increased inflammation of the leptomeninges (F). Examples of CD68+ microglia of a subpial GM lesion (G) and CD68+ microglia/macrophages in a white matter lesion (H). Examples of 1-3 rated inflammatory infiltrates (“+” to “+++”) of the forebrain meninges [I-N with (L-N) being higher power images of (I-K), respectively]. Please note that infiltrates (I, L, K, N) are near partially de/re-myelinated cortex of cortical High GML Case MS257. Cx: cortical; GML: grey matter lesion; NGM: normal appearing grey matter; NWM: normal appearing white matter; PLP: proteolipid protein immunohistochemistry; WML: white matter lesion. (G-K) Scale bar = 100µm; (L-N) Scale bar = 25 µm