[Myelopathy complicating acute bacterial meningitis (author's transl)]

Four cases of acute bacterial meningitis complicated by medullary involvement are described. The complication presenting as a transverse myelitis occurred early and suddenly in the course of severe bacterial meningitis caused by different bacteria. Only two other comparable cases have been reported.

[Acute toxoplasmic myelitis in the newborns]

The present paper describes 3 patients with congenital toxoplasmosis. The spinal cord was extremely affected. Differential diagnoses were established with poliomyelitis and neonatal hypoxia. Histopathological studies revealed toxoplasmosis.

Transverse myelitis in mixed connective tissue disease

Neurologic disease is reported to occur in just 10% of patients with mixed connective tissue disease (MCTD). Most commonly, this is manifested by mild trigeminal neuralgia. This report details the clinical and neuropathologic findings of transverse myelitis in a patient with MCTD. Neurologic features include progressive areflexic paraplegia with loss of bowel and bladder function. Neuropathologically there was thinning of the thoracic cord, widespread loss of axons and myelin sheaths, reactive astrocytosis, macrophage formation, vascular thickening with perivascular chronic inflammatory cell infiltration, and calcium deposits. This case demonstrates that severe neurologic disease unresponsive to therapy can occur in MCTD.

Myelopathy presenting as an intrinsic spinal cord tumor

Two patients are presented who became progressively quadriplegic with myelographic appearances suggesting intrinsic spinal cord tumors. In both cases, laminectomy and biopsy of the spinal cord disclosed non-neoplastic conditions (neuromyelitis optica and acute necrotic myelopathy) confirmed at autopsy. Since surgery is not helpful in such cases, the problems of differentiation between such lesions and intraspinal tumors are reviewed.

Autoimmune and virus-induced demyelinating diseases. A review

Patterns of demyelination are described in several autoimmune and virus-induced demyelinating diseases of the peripheral and central nervous system. Myelin can be destroyed by injuries that affect either the myelin-supporting cells and/or the myelin lamellae. After destruction of the supporting cells, the related disintegrating sheaths are stripped off axons by invading phagocytes. Virus-induced cytolysis can occur with or without participation of immune responses, as demonstrated in subacute sclerosing panencephalitis and progressive mutlifocal leukoencephalopathy, respectively. Autoimmune demyelination is characterized by disintegration of myelin sheaths in periventular, mononuclear cell infiltrates. Myelin lamellae rather than the myelin-supporting cells are the target of the allergic reaction. The lamellae are lysed in focal areas when in contact with presumably sensitized mononuclear cells. The damaged sheaths are then removed in a nonspecific manner by invading macrophages that strip the myelin remnant off the axons. This sequence of changes is best revealed in experimental and human autoimmune demyelination of peripheral nerves, ie, allergic neuritis and idiopathic polyneutris (the Guillain-Barré syndrome). Autoimmune demyelination triggered by virus infection is described in Marek's disease and postinfectious Theiler's virus myelitis. Changes in canine distemper are discussed with reference to both autoimmune and virus-induced demyelination. The observations are compared with lesions in multiple sclerosis, the most common human demyelinating disease of unknown etiology.

A comparison of myelopathy associated with megavoltage irradiation and remote cancer

Two middle-aged women with malignancy of the aerodigestive tract were treated by megavoltage irradiation. Both subsequently developed transverse myelopathy. The diagnosis of radiation myelitis was rendered in one. The other was thought to have metastatic compression of the spinal cord; in this case, evidence was such that radiation myelopathy also was appropriate. The irradiation dose-time relationships in both patients were biologically low compared to published isoeffect curves available in the literature. The first patient had injury within the irradiated region and the main neurological damage was found there. In the second patient the entire spinal cord was necrotic, clearly placing the second case outside the radiation myelopathy syndrome. Gross and microscopic examinations of the tissues of these two patients show that the remote effects of malignancy upon the central nervous system can imitate the clinical picture of radiation myelitis.

Ultrastructural study of a muscle biopsy from a patient with subacute myelo-optic neuropathy

A man, aged 46, who had been taking Clioquinol in high doses for a long period, developed a characteristic neurological syndrome of subacute myelo-optic neuropathy rather abruptly. Electron microscopical examination of the muscle biopsy, obtained five months after the onset of the disease, revealed severe degenerative changes of the presynaptic nerve endings and some unique paracrystalline inclusions in the sole plate region. The latter may represent the morphological expression of the toxic agent which is held responsible for the subacute myelo-optic neuropathy.

Neurological manifestations of gnathostomiasis

Neurological features of 24 patients with nervous system gnathostomiasis were reviewed. The commonest presenting features were radiculomyelitis or radiculomyelitis terminating with encephalitis, and subarachnoid haemorrhage. A primary encephalitic form was noted in 2 patients. The salient feature of the disease was a sudden onset of extremely severe radicular pain and/or headache followed by paralysis of the extremities and/or the cranial nerves. Migration signs were also the hallmark of nervous system gnathostomiasis. No single area of the nervous system was inaccessible to the highly invasive gnathostome lava. Multiplicity and/or rapid progress of lesions beyond the degree of cerebral oedema could only be explained by further migration of the parasite. Death occurred in 6 patients from direct extensive involvement of vital centres in the brain stem or from complications such as pneumonia or septicaemia. Multiple cranial nerve palsies were usually bad prognostic signs.