Pathology

Degeneration

Myelin is primarily involved in immune- and virusmediated diseases, hereditary and acquired metabolic diseases, and various toxic disorders. It is also affected in vascular, infectious, and traumatic disorders, and in wallerian degeneration of the axons. The pattern of myelin degeneration is the same regardless of the cause. The myelin sheath swells, becomes irregular, and breaks down first into larger, and then smaller and smaller globules, which contain cholesterol ester and triglycerides. These globules are phagocytosed and gradually removed by macrophages to the perivascular and sub-arachnoid spaces (see Fig. 2.10).

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