Chemical pathology of acute demyelinating lesions and its correlation with disability

Ann Neurol. 1995 Dec;38(6):901-9. doi: 10.1002/ana.410380610.


We report the chemical pathological changes on magnetic resonance spectroscopic images of 4 patients, each of whom had a single large demyelinating plaque. The patients were followed from soon after the onset of the symptoms for a minimum of 7 months to a maximum of 3 1/2 years. We observed increases in the relative resonance intensities of choline-containing compounds, lactate, and myo-inositol inside the lesion acutely. Decreases in relative resonance intensities of N-acetylaspartate and creatine were seen both in and around the magnetic resonance imaging-detected lesions. In all patients neurological deficits improved and creatine, lactate, and myo-inositol resonance intensities normalized during the follow-up. Choline compounds recovered more slowly and were still abnormally high in 1 patient after 7 months. Partial recovery of the N-acetylaspartate resonance was seen for all patients. Evaluation of the relationships between indices of cerebral chemical pathology, brain lesion volumes, and functional disability showed highly significant negative correlations between N-acetylaspartate resonance intensities and both brain lesion volumes (r = -0.80, p < 0.0001) and clinical disability (r = -0.73, p < 0.0001). As N-acetylaspartate is localized solely in neurons in the adult central nervous system, our results suggest that neuronal dysfunction may be a proximate mechanism of disability even in inflammatory disorders primarily affecting myelin and oligodendroglial cells.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aspartic Acid / analogs & derivatives
  • Aspartic Acid / analysis
  • Brain Chemistry
  • Choline / metabolism
  • Demyelinating Diseases / diagnosis
  • Demyelinating Diseases / metabolism
  • Demyelinating Diseases / pathology*
  • Disability Evaluation*
  • Female
  • Humans
  • Inositol / analysis
  • Lactates / analysis
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Male


  • Lactates
  • Aspartic Acid
  • Inositol
  • N-acetylaspartate
  • Choline