Both acute transverse myelitis (ATM) and Guillain-Barré syndrome (GBS) occur as rare associations with mumps viraemia but to our knowledge, concurrent ATM and GBS related to mumps has only been reported once previously. We describe the case of a young woman presenting with confusion and collapse 2 weeks after a flu-like illness. An initial diagnosis of transverse myelitis was made on the basis of the clinical findings and radiological evidence of a swollen spinal cord with uniform high signal change on T2 weighted MRI. The patient was treated with intravenous methylprednisolone without significant recovery. The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy. Acute mumps viraemia was confirmed on serological grounds. The patient made an improvement in ventilatory capacity with intravenous immunoglobulin treatment.

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Chronic progressive compression of the optic nerve in the cat was produced by an inflatable silicon rubber balloon implanted in the orbit. Within the first week the predominant pathological change was demyelination. Both partially and completely demyelinated fibres were seen at all stages of the experiments but by the fifth week some axons had been remyelinated by oligodendrocytes despite the continued presence of the balloon. The myelin sheaths of the new internodes were abnormally thin and short, and many showed an atypical paranodal organization. There was evidence of breakdown of some of the new internodes. The pathophysiology of optic nerve compression in man is reviewed.

The transformation of lymphocytes in vitro in the presence of human myelin basic protein has been investigated in normal people, patients with multiple sclerosis (MS) and controls with other neurological diseases. There was little or no response at low concentrations (1-10 pg/ml) but significant transformation at higher concentrations (100-1000 pg/ml) in all three groups. There was no significant difference among the groups as a whole, but those MS patients who had had disease for more than 10 years did show greater responses than normal subjects (P<0.05). Increased responses could not be correlated with any other aspect of disease activity: in particular they were not increased in patients with acute relapses. The use of autologous serum instead of homologous AB Rhesus positive serum did not significantly alter lymphocyte responsiveness. The absence of any response in the presence of purified calf thymus histone suggests that the response to myelin basic protein indicates a low level of lymphocyte sensitization to this antigen even in normal subjects. The present evidence does not support a primary pathogenetic role for such a reaction in MS. The increased response in patients with a long duration of disease might merely be an effect of white matter damage or might represent an amplification of the normal immune response contributing to myelin breakdown and leading to the emergence of the progressive stage of the disease. The study of lymphocyte responsiveness over a wide range of concentrations of myelin basic protein is considered to resolve some of the controversy surrounding this subject in the literature.Experimental allergic encephalomyelitis is still proposed as a model of MS because it is histologically similar to the human disease and chronic forms can be produced (Snyder et al. 1975). The experimental disease is known to require a cell-mediated immune reaction against myelin basic protein which can be demonstrated by positive intradermal skin tests in vivo or by lymphocyte transformation or macrophage inhibitory factor production in vitro. If experimental allergic encephalomyelitis is relevant to MS, clinical immunological evidence of sensitization to myelin basic protein should be obtainable 0001-6314/79/080065-12 $0.2.50/0 @ 1979 Munksgaard, Copenhagen 5' gen-binding lymphocytes in normal man and guinea pig to human encephalitogenic protein.