689 M.s.-treated PAM cells and controls. These differences, and the specificity of the reaction for rhesus-monkey cells, give further evidence for the presence of a replicating virus-like agent in M.S. tissues. Department of Microbiology and Animal Experimentation, New York State Institute for Research in Mental Retardation, 1050 Forest Hill Road, Staten Island, N.Y. 10314, U.S.A.
HELEN B. WARNER RICHARD I. CARP ROBERT NARDUCCI
COMPUTERISED AXIAL TOMOGRAPHY IN MULTIPLE SCLEROSIS attention has been given to the possibility of SIR,-Little in the brain or optic nerves lesions detecting demyelinating using E.M.I. computerised axial tomography (C.A.T.), and we have seen no report of C.A.T. findings in patients with multiple sclerosis (M.S.). We have studied 19 patients in whom a diagnosis of M.S. was established or felt to be probable on clinical grounds and on the basis of cerebrospinal-fluid visual and spinal somatosensory evoked potential findings and studies. I2 Examination was performed on the E.M.I. scanner using a 160x160 matrix, plain standard tomographic cuts of the cranium being taken in each case with additional cuts of the orbits in 4. The findings were: normal (6), cerebral plaques (7), optic-nerve plaques (3), and atrophy (4). In 4 patients with a typical acute remitting or relapsing syndrome with clinical manifestations referable to the cerebral hemispheres, single or multiple plaques of demyelination were identified in the white-matter of one or both hemispheres as areas of reduced density (low fl numbers) the margins of which were usually not sharply demarcated from the surrounding normal white-matter (figure, a). In one patient with a remitting brainstem syndrome a lesion compatible with a plaque was demonstrated in one temporal lobe. In 2 patients it was possible to recognise similar small lesions in the cerebellar hemispheres and pons but the interpretation of lesions in these sites was more difficult than in the cerebral hemispheres. In 3 of the 4 patients who had orbital examinations, all of whom had clinical evidence of optic-nerve involvement, examination of the INVERT 160x 160 computer print-out in conjunction with the ’Polaroid’ photograph of the corresponding orbital cut through the optic nerves showed small areas ofvalues inappropriately close to 0 in one or both nerves. These were usually situated in the intraorbital segment of the optic nerve close to the optic foramen and were considered to be compatible with plaques of demyelination. In 1 patient with cerebral M.S. who had a second scan five weeks after the first, extension of a typical paraventricular cerebral hemisphere plaque shown on the first scan was noted, and additional plaques were demonstrated in both hemispheres and in both optic nerves (see figure). A considerable degree of generalised ventricular dilatation which was associated with a commensurate degree of widening of the cortical sulci and of the sylvian and ambient cisterns and interhemispheric fissure was found in 4 patients with chronic cerebrospinal M.S. and a lesser degree of atrophy was found in one other patient. These findings indicate that it is possible to detect demyelinating lesions in the brain and optic nerves by C.A.T. and to follow the temporal and spatial evolution of the lesions in the central nervous system (c.N.s.) using this technique. Although the characteristics of the individual lesions do not allow them to be conclusively differentiated from small isctue1 Halliday, A M., McDonald, W. I., Mushin, J. Br. med. J. 1973, iv, 661. F. L., Black, J. L., Collins, D. W. K. Paper read at the 24th
2 Mastaglia,
annual scientific meeting of the Australian Association of held in Auckland, New Zealand, in February, 1976.
Neurologists,
C.A.T. appearances in 28-year-old
male with cerebral M.S.
(a) First scan (2B slice) showing plaque responsible for right homonymous visual field defect (arrowhead). (b) Second scan (3A slice) showing the original and two additional plaques (arrowheads). other deep-seated focal destructive lesions,34 the of multiple lesions, of lesions in a paraventricular situation, and of additional lesions in the optic nerves, is highly suggestive of M.S. The ability to detect clinically silent plaques of demyelination in the cerebral hemisphere with this technique in patients presenting with a symptomatic lesion elsewhere in the C.N.S. emphasises its value in the diagnosis of M.S., a condition in which the demonstration of multiple lesions is one of the prerequisites for establishing the diagnosis. mic
or
finding
Department of Radiology, Perth Medical Centre, Perth, Western Australia
L. A. CALA
University Department of Medicine,
F. L. MASTAGLIA
Perth Medical Centre
INTRATHECAL RUBELLA-ANTIBODY SYNTHESIS IN MULTIPLE SCLEROSIS
SIR,-Progressive panencephalitis in children is occasionally associated with rubella-virus infection. 1-7 Similarly in some cases of multiple sclerosis (M.S.) synthesis of measles antibodies in .the central nervous system (C.N.S.) has been demonstrated.* We report here one case of M.S., with production of rubella antibodies in the C.N.S. A 30-year-old woman has a disease reminiscent of M.S., beginning in 1958 with motor and sensory symptoms in all four limbs which regressed within 3 weeks. During a relapse 1 year later (1959) she had horizontal diplopia which lasted 8 days. Between 1959 and 1974 she had many relapses, usually lasting 4-8 days and characterised by motor signs. In November, 1974, rotatory vertigo appeared and lasted 8 days. Since December, 1974, she has had weakness and pain in both legs when she walks. Remissions are now only partial, and the patient is subject to paraesthesia of upper limbs and bladder signs with urinary urgency. She has pain on anterior flexion of the neck, pyramidal signs, hypertonia of lower limbs, and spastic walk, but no ocular signs. 3. 4.
Cala, Cala,
L. A. ibid. L. A., Mastaglia, F. L.
Brazilian
Meeting
of
Paper read
Neuroradiology,
the 2nd Inter-American and 6th held in Rio de Janeiro, Brazil, in
at
February, 1976. 5. Lebon, P., Lyon, G. Lancet, 1974, ii, 468. 6. Townsend, J. J., and others New Engl. J. Med. 1975, 292, 990. 7. Weil, M. L., Itabashi, H. H., Cremer, N. E., Oshiro, L. S., Lennette, E. H., Carnay, L. ibid. 1975, 292, 994. 8. Salmi, A., Norrby, E., Panelius, M. Infect. Immun. 1972, 6, 248.
690
During the latest relapse in November, 1975, we studied the blood and cerebrospinal fluid (c.s.F.) of this patient. Analysis of the c.s.F. has shown an inflammatory reaction: 11 lymphocytes/µl and 390 fJ-g protein/ml, with 41% gamma-globulins. Electrophoresis on cellulose acetate revealed two/bands of gamma-globulins determined at 39 and 54 g/ml. Rubella, measles, parainfluenza III, and Sendai antibodies were titrated by the haemagglutination-inhibition test; polio in and herpes I antibodies by neutralisation of the cytopathogenic effect. The antibody ratio c.s.F./serum was the highest with rubella: Virus
Antibody serum
Rubella Measles Parainfluenza Sendai Polio 111
Herpes
160 160 320 160 20
111
HELEN B. WARNER RICHARD I. CARP ROBERT NARDUCCI
COMPUTERISED AXIAL TOMOGRAPHY IN MULTIPLE SCLEROSIS attention has been given to the possibility of SIR,-Little in the brain or optic nerves lesions detecting demyelinating using E.M.I. computerised axial tomography (C.A.T.), and we have seen no report of C.A.T. findings in patients with multiple sclerosis (M.S.). We have studied 19 patients in whom a diagnosis of M.S. was established or felt to be probable on clinical grounds and on the basis of cerebrospinal-fluid visual and spinal somatosensory evoked potential findings and studies. I2 Examination was performed on the E.M.I. scanner using a 160x160 matrix, plain standard tomographic cuts of the cranium being taken in each case with additional cuts of the orbits in 4. The findings were: normal (6), cerebral plaques (7), optic-nerve plaques (3), and atrophy (4). In 4 patients with a typical acute remitting or relapsing syndrome with clinical manifestations referable to the cerebral hemispheres, single or multiple plaques of demyelination were identified in the white-matter of one or both hemispheres as areas of reduced density (low fl numbers) the margins of which were usually not sharply demarcated from the surrounding normal white-matter (figure, a). In one patient with a remitting brainstem syndrome a lesion compatible with a plaque was demonstrated in one temporal lobe. In 2 patients it was possible to recognise similar small lesions in the cerebellar hemispheres and pons but the interpretation of lesions in these sites was more difficult than in the cerebral hemispheres. In 3 of the 4 patients who had orbital examinations, all of whom had clinical evidence of optic-nerve involvement, examination of the INVERT 160x 160 computer print-out in conjunction with the ’Polaroid’ photograph of the corresponding orbital cut through the optic nerves showed small areas ofvalues inappropriately close to 0 in one or both nerves. These were usually situated in the intraorbital segment of the optic nerve close to the optic foramen and were considered to be compatible with plaques of demyelination. In 1 patient with cerebral M.S. who had a second scan five weeks after the first, extension of a typical paraventricular cerebral hemisphere plaque shown on the first scan was noted, and additional plaques were demonstrated in both hemispheres and in both optic nerves (see figure). A considerable degree of generalised ventricular dilatation which was associated with a commensurate degree of widening of the cortical sulci and of the sylvian and ambient cisterns and interhemispheric fissure was found in 4 patients with chronic cerebrospinal M.S. and a lesser degree of atrophy was found in one other patient. These findings indicate that it is possible to detect demyelinating lesions in the brain and optic nerves by C.A.T. and to follow the temporal and spatial evolution of the lesions in the central nervous system (c.N.s.) using this technique. Although the characteristics of the individual lesions do not allow them to be conclusively differentiated from small isctue1 Halliday, A M., McDonald, W. I., Mushin, J. Br. med. J. 1973, iv, 661. F. L., Black, J. L., Collins, D. W. K. Paper read at the 24th
2 Mastaglia,
annual scientific meeting of the Australian Association of held in Auckland, New Zealand, in February, 1976.
Neurologists,
C.A.T. appearances in 28-year-old
male with cerebral M.S.
(a) First scan (2B slice) showing plaque responsible for right homonymous visual field defect (arrowhead). (b) Second scan (3A slice) showing the original and two additional plaques (arrowheads). other deep-seated focal destructive lesions,34 the of multiple lesions, of lesions in a paraventricular situation, and of additional lesions in the optic nerves, is highly suggestive of M.S. The ability to detect clinically silent plaques of demyelination in the cerebral hemisphere with this technique in patients presenting with a symptomatic lesion elsewhere in the C.N.S. emphasises its value in the diagnosis of M.S., a condition in which the demonstration of multiple lesions is one of the prerequisites for establishing the diagnosis. mic
or
finding
Department of Radiology, Perth Medical Centre, Perth, Western Australia
L. A. CALA
University Department of Medicine,
F. L. MASTAGLIA
Perth Medical Centre
INTRATHECAL RUBELLA-ANTIBODY SYNTHESIS IN MULTIPLE SCLEROSIS
SIR,-Progressive panencephalitis in children is occasionally associated with rubella-virus infection. 1-7 Similarly in some cases of multiple sclerosis (M.S.) synthesis of measles antibodies in .the central nervous system (C.N.S.) has been demonstrated.* We report here one case of M.S., with production of rubella antibodies in the C.N.S. A 30-year-old woman has a disease reminiscent of M.S., beginning in 1958 with motor and sensory symptoms in all four limbs which regressed within 3 weeks. During a relapse 1 year later (1959) she had horizontal diplopia which lasted 8 days. Between 1959 and 1974 she had many relapses, usually lasting 4-8 days and characterised by motor signs. In November, 1974, rotatory vertigo appeared and lasted 8 days. Since December, 1974, she has had weakness and pain in both legs when she walks. Remissions are now only partial, and the patient is subject to paraesthesia of upper limbs and bladder signs with urinary urgency. She has pain on anterior flexion of the neck, pyramidal signs, hypertonia of lower limbs, and spastic walk, but no ocular signs. 3. 4.
Cala, Cala,
L. A. ibid. L. A., Mastaglia, F. L.
Brazilian
Meeting
of
Paper read
Neuroradiology,
the 2nd Inter-American and 6th held in Rio de Janeiro, Brazil, in
at
February, 1976. 5. Lebon, P., Lyon, G. Lancet, 1974, ii, 468. 6. Townsend, J. J., and others New Engl. J. Med. 1975, 292, 990. 7. Weil, M. L., Itabashi, H. H., Cremer, N. E., Oshiro, L. S., Lennette, E. H., Carnay, L. ibid. 1975, 292, 994. 8. Salmi, A., Norrby, E., Panelius, M. Infect. Immun. 1972, 6, 248.
690
During the latest relapse in November, 1975, we studied the blood and cerebrospinal fluid (c.s.F.) of this patient. Analysis of the c.s.F. has shown an inflammatory reaction: 11 lymphocytes/µl and 390 fJ-g protein/ml, with 41% gamma-globulins. Electrophoresis on cellulose acetate revealed two/bands of gamma-globulins determined at 39 and 54 g/ml. Rubella, measles, parainfluenza III, and Sendai antibodies were titrated by the haemagglutination-inhibition test; polio in and herpes I antibodies by neutralisation of the cytopathogenic effect. The antibody ratio c.s.F./serum was the highest with rubella: Virus
Antibody serum
Rubella Measles Parainfluenza Sendai Polio 111
Herpes
160 160 320 160 20
111
