Open Access Highly Accessed Review

Cortical injury in multiple sclerosis; the role of the immune system

Caroline A Walker1, Anita J Huttner2 and Kevin C O'Connor13*

Author Affiliations

1 Department of Neurology, Yale School of Medicine, 15 York Street, PO Box 208018 New Haven, CT 06520-8018, USA

2 Department of Pathology, Yale School of Medicine, 310 Cedar Street LH 108 PO Box 208023, New Haven, CT 06520-8023, USA

3 Human and Translational Immunology Program, Yale School of Medicine, The Anlyan Center for Medical Research & Education, 300 Cedar Street P.O. Box 208011, New Haven, CT 06520, USA

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BMC Neurology 2011, 11:152  doi:10.1186/1471-2377-11-152

Published: 6 December 2011


The easily identifiable, ubiquitous demyelination and neuronal damage that occurs within the cerebral white matter of patients with multiple sclerosis (MS) has been the subject of extensive study. Accordingly, MS has historically been described as a disease of the white matter. Recently, the cerebral cortex (gray matter) of patients with MS has been recognized as an additional and major site of disease pathogenesis. This acknowledgement of cortical tissue damage is due, in part, to more powerful MRI that allows detection of such injury and to focused neuropathology-based investigations. Cortical tissue damage has been associated with inflammation that is less pronounced to that which is associated with damage in the white matter. There is, however, emerging evidence that suggests cortical damage can be closely associated with robust inflammation not only in the parenchyma, but also in the neighboring meninges. This manuscript will highlight the current knowledge of inflammation associated with cortical tissue injury. Historical literature along with contemporary work that focuses on both the absence and presence of inflammation in the cerebral cortex and in the cerebral meninges will be reviewed.