THE HISTOLOGY OF DISSEMINATED SCLEROSIS. 717 



the transverse fibres of the pons begin to form the middle cerebellar peduncle. At the 

 level of the decussation of the superior cerebellar peduncles (fig. 208) a large dense area is 

 found at the anterior surface : this involves the superficial fibres, the adjacent grey matter, 

 and the pyramidal fibres. A few small early patches can be traced amongst the transverse 

 fibres of the pons, and a well-marked triangular area lies close to the left corner of the 

 aqueduct of Sylvius. 



Cerebral Hemispheres. — Horizontal sections at the level of the lower and upper parts 

 of the optic thalamus show that only a very slight degree of peri-ventricular involvement 

 is present. This is an area of shadow sclerosis related to the posterior horn, and is of very 

 slight extent. No other definite areas can be found in these sections, but at higher levels 

 two or three small cortical and subcortical areas can be found in each section. An extensive 

 demyelination of the superficial layers of the cortex of several convolutions is also present. 



Case IX. 



Clinical Notes. 



L. H. — The patient, aged thirty, was admitted to Longmore Hospital on 24th May 1911, 

 dying on 13th July 1911. 



As a school-girl she had always been healthy, although she has been late in walking. 

 She used to take part in all games and gymnastics and was quite strong until she reached 

 the age of twenty, when she began to notice a loss of power in her right foot. About this 

 time she had an attack of chorea. For the last six years she has got decidedly worse, and 

 has had to remain in bed. Only the lower limbs and the bladder were affected. 



Post-mortem Report, 15th July 1911. 



Marked contracture of both lower limbs. Bed-sores over both hips and left shoulder. 



Brain. — No adhesions of the dura. Some excess of clear cerebro-spinal fluid. Some 

 congestion of cortical vessels and pia mater and cedematous fluid under the pia. Convolu- 

 tions somewhat atrophied. Gelatinous patch of disseminated sclerosis at junction of medulla 

 and cord. The right Vlllth nerve appeared to be atrophied. 



Spinal Cord. — Very small. On section numerous patches of typical disseminated sclerosis 

 were seen. 



Lungs. — Right : firm adhesion at the base. Pale in front, hypogastric congestion 

 posteriorly. On section marked oedema in upper lobe, congestion in lower. Left : in 

 a somewhat similar condition. 



The heart was small and flabby ; no valvular disease. 



The liver was enlarged and pale, with considerably fatty change. 



The spleen was very small, and the post-mortem discoloration was marked. 



The left kidney was a little enlarged, with the appearance of subacute parenchymatous 

 nephritis : the capsule stripped freely. 



General Characters of the Areas. 



This case, also, presented a marked contrast between the areas in the spinal cord and 

 those in the brain. The former were almost wholly in the stage of advanced sclerosis : the 

 majority of the latter were in a stage of fat granule cell formation. 



In the cord the only extensive affection was found in the lower sacral region (figs. 238- 

 239). Throughout the lumbar cord there was a remarkable symmetry in the small areas 

 found in this region — especially in those which involved groups of nerve cells in the anterior 

 horns of grey matter. Few fat granule cells could be found at any level, and those present 



TRANS. ROY. SOC. EDIN., VOL. L, PART III (NO. 18). 9.9 



