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A highly suggestive correlation between blood ammonia levels on the one hand and alterations of mental status and characteristic involuntary movements on the other in patients with liver disease has been reported by many workers. 1-5 Complete reviews of our current knowledge of ammonia metabolism have been published recently by Bessman 6 and by Chalmers. 7 The concept of a relationship of blood and cerebrospinal fluid (CSF) ammonia levels to neurologic findings apart from mental changes and the typical hepatic "flap," however, has received relatively little attention. In particular, the correlation of specific findings in either the neurologic, general physical, or laboratory examinations of patients with liver disease, with blood or CSF ammonia levels has not, to our knowledge, been the subject of any rigorous study. The principal purpose of this report is to determine whether the ammonia levels of blood and cerebrospinal fluid of patients with liver disease have

RECENT reports1have called attention to the importance of a differential diagnosis of supracervical and cervical lesions, especially those due to herniated cervical disk. Some authors have observed that nystagmus is associated with lesions of the cervical portions of the cord. Obviously, it is then important, for diagnostic purposes, to determine the frequency of nystagmus in cervical lesions. In view of the relative paucity of reports in the literature, it was decided to investigate this matter. REVIEW OF THE LITERATURE Kraus and Silverman2reported one case of osteofibroma of the odontoid process with nystagmus, one of intramedullary glioma at the third cervical segment with nystagmoid jerks, and one of intramedullary sarcoma at the first to the fourth cervical segment with distinct nystagmus to the right. Nystagmus has even been discovered in association with lesions of the thoracic segments. Thus, Wiersma3reported an intradural fibroma at the seventh

To the Editor: —Because of conflicting reports in the literature (Lereboullet, J.; Pluvinage, R., and Coty, R.: Vitamin B12in Multiple Sclerosis,J. A. M. A.143:1272 [Aug. 5] 1950. Schumacher, G. A.: Treatment of Multiple Sclerosis,J. A. M. A.143:1241 [Aug. 5] 1950) regarding the effectiveness of vitamin B12 in the treatment of multiple sclerosis, we undertook a study, on the basis of thorough history and neurologic and laboratory examinations, of 24 patients in whom a diagnosis of multiple sclerosis was considered justifiable. Of these, six were treated in the hospital and 18 in the outpatient department. The six hospitalized patients received 100 micrograms of vitamin B12 intramuscularly every other day for a three-month period. Of this group, five received 1,000 micrograms every other day for an additional three-month period. Fifteen outpatients received 100 micrograms three times a week for three months. Two outpatients received