Surface-in pathology in multiple sclerosis: a new view on pathogenesis?

Abstract While multiple sclerosis can affect any part of the CNS, it does not do so evenly. In white matter has long been recognized that lesions tend to occur around ventricles, and grey mainly accrue in outermost (subpial) cortex. cortical matter, neuronal loss is greater layers. This gradient replicated vivo with magnetization transfer ratio similar gradients are seen most severe abnormalities abutting ventricular surface. The cause these remains uncertain, though soluble factors released from meningeal inflammation into CSF supporting evidence. this Update, we review ‘surface-in’ spatial distribution consider implications for understanding pathogenic mechanisms treatments designed slow or stop them.