THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 549 



band of sclerosis was also found to surround the aqueduct of Sylvius, but here the 

 ependymal epithelium was greatly modified. The writers refer to the possible 

 pathogenic significance of these peri-ventricular lesions, and think it probable that 

 the toxi-infectious agent, whose nature is not suggested, may diffuse through two 

 channels : the one the more constant, represented by the blood-vessels ; the other, of 

 lesser importance, the cerebro-spinal fluid. 



Merle and Pastine (1910) also refer to a case in which the ependymal and 

 peri-ependymal change was the dominant pathological feature. They agree with 

 Lhermitte and Guccione in regarding the existence of lesions in such a special 

 localisation as probably of great pathognomonic significance. References are given 

 to other cases, which show that irritation of the ventricular walls must be considered 

 a not uncommon feature of the disease. 



Weisenberg and Ingham (1910). The most interesting points of the case 

 reported by these authors are : (l) the atrophy of the brain — rare in disseminated 

 sclerosis — and the undoubted hypoplasia of certain parts, which is here doubtless 

 congenital ; (2) the primary degeneration of the pyramidal tracts, which is in no way 

 related to the sclerosis ; (3) the presence of developmental anomalies. 



Spielmeyer (1910) has specially studied the relation between disseminated 

 sclerosis and progressive paralysis. He distinguishes clearly between the diffuse 

 cortical medullated fibre atrophy in general paralysis and the irregularly distributed 

 patches which bear a striking resemblance to the cortical areas in disseminated 

 sclerosis. He thinks that many cases of disseminated sclerosis in the intensity of 

 their psychic disturbances bear a great similarity to the clinical picture of progressive 

 paralysis. In general, in the latter disease there are no sclerotic patches found in the 

 cord, but Furstner has found, in addition to the system degeneration in the posterior 

 and lateral columns a more diffuse and patchy sclerosis in the cord, areas in which 

 there was dense glia proliferation, and in the cord of the case which forms the 

 subject of this article, Spielmeyer also found, in the lumbar cord, definite patches 

 with all the characters of the areas in disseminated sclerosis. In sixty other cases 

 of general paralysis he has failed to find sclerotic areas in the cord, but thinks a 

 definite relation exists between the cortical areas in the two affections. 



In a case which clinically was general paralysis, there were found two varieties of 



medullated fibre atrophy : (l) the usual more diffuse fibre degeneration, and (2) a 



local accentuated form in which spots and striae had led to a limited demyelination 



of the cortex and to changes which were designated as cortical Markfrasse. 



These spots and striae were found most frequently in the radiations of the medullary 



ray, were sometimes limited to the region of the deep cortex, were sometimes in the 



intra-medullary cortex, and sometimes led to complete obliteration of the fibres in 



the cortex. The areas appeared sometimes only isolated in individual convolutions, 



and in other parts, especially in the anterior two-thirds of the hemispheres, were so 



numerous as to give the convolutions a moth-eaten appearance. In preparations 

 TRANS. ROY. SOC. EDIN., VOL. L, PART III (NO. 18). 78 



