Two unusual neuropathologically proven cases of multiple sclerosis from bombay

Abstract

Two unusual cases of multiple sclerosis (MS), both from Bombay, have been reported with detailed clinical and histopathological findings, which evidenced dissemination in time and in space. They were both women in their twenties, with total duration of the neurological illness of 5–6 months. The first patient had initial signs related to the optic nerves and then, after remission, to the brain stem and spinal cord. There were chronic plaques in the medulla, in 1 optic nerve and lesions of varying stages throughout the cervical spinal cord, with glial cellular and fibrillar reaction, and some preservation of axons. This appeared to be a case of MS with features simulating neuromyelitis optica. The second patient had initial signs related to the lumbar cord, like a transverse myelitis and then, after a remission, evidence of a progressive cerebral disorder with clinical and ventriculographic findings suggesting a space-occupying lesion in the corpus callosum and frontal lobes. The more chronic demyelination was in the spinal cord. The brain showed large, recent, symmetrical, periventricular plaques, with total absence of myelin except in some of the U-fibres, throughout the frontal and parietal lobes and anterior corpus callosum. There was moderate lymphocytic reaction in and around the vessels, extensive accumulation of myelin breakdown products in histiocytes (gemistocytes and gitter cells) with some preservation of axons and early gliosis. This appeared to be a case of MS with some features of diffuse cerebral sclerosis, or what is often called transitional type of MS. A history of smallpox vaccination 5 weeks before the illness in the first case, and the chronic inflammatory reaction in the second, together with the rapid tempo of the disease in both, which determined the characteristic patterns of clinical and pathological changes, has led us to discuss the infectious and allergic hypotheses of aetiology in MS.