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Lesions consistent with demyelinating plaques were retrospectively identified in the cervical spinal cord of 15/49 patients (31%) with multiple sclerosis examined with cranial and cervical MR imaging. The lesions appeared as hyperintense areas on proton-density and T2-weighted images. Clinical signs and symptoms suggestive of spinal cord location of the demyelinating plaques were observed in 14 of the 15 patients presenting with spinal cord lesions at MR, and also in 11 of the 34 patients with negative MR findings. In 2 patients the cervical lesion was not associated with brain lesions at MR, while in 1 patient it was associated with medullary dilatation. Serial MRs revealed disappearance of the cervical hyperintense area in both patients, and reduction in medullary volume in the latter. Therefore, MR imaging of the cervical spinal cord is suggested as an useful examination in patients with suspected multiple sclerosis, particularly in those presenting with clinical signs and symptoms suggestive of spinal cord involvement.

14 patients with chronic progressive multiple sclerosis, selected in a preliminary uncontrolled trial, were given a short course of intensive cyclophosphamide therapy, which was discontinued when the leukocyte count fell to 3000 cu.mm. 5 patients dropped out because of severe side effects. At 1 year follow-up were neurologically unchanged since admission to the trial; 4 remained stable at 2 years. The lack of clinical improvement, the high frequency of side effects and the proven oncogenicity of cyclophosphamide led us to discontinue the trial.

Of the various scoring systems employed to assess the neurological status in Multiple Sclerosis (MS), the Kurtzke functional system and disability status scale are the most used even for international comparisons. In order to assess inter- and intra-observer variability in the employment of Kurtzke's scale, 70 patients with definite MS were scored by 4 neurologists independently: 40 subjects were assessed using the Kurtzke scoring system and 30 patients using the Kurtzke system as modified by the Italian Multicenter MS Case-Control Study Group. Each of the patients was examined by one of the 4 neurologists in turn and in the presence of the other three. The same neurological examination was scored again after 1 month by the same neurologists. Agreement was estimated using the weighted Kappa index. The results indicated a high level of concordance both for intra- and inter-observer comparisons on all the items. No significant difference in reliability was found using the two scales examined.

As the effectiveness of continuous azathioprine therapy in multiple sclerosis (MS) is still controversial, we have conducted a prospective trial of the drug (2 mg/kg daily for at least 2 years) in patients with clinically definite MS, ie with remitting, remitting-progressive and progressive MS. At the end of an average 3-year follow-up 65% of the 40 patients with remitting-progressive had the same EDSS score as they had to start with. This was observed mainly in patients with longstanding MS and a high baseline EDSS. Of the 22 patients with a remitting course 77% showed no clinical deterioration and the annual relapse rate declined, although not significantly. In only one case did the remitting disease become remitting-progressive. Azathioprine would seem to have some efficacy in delaying the progression of remitting MS.

The direction of CSF flow within the cerebral aqueduct was studied by cardiac-gated magnetic resonance (MR) phase images in five healthy volunteers and 10 patients with presumably normal cerebral CSF circulation. Caudal CSF flow was observed during systole and cranial flow during diastole. Using phantom based calibrations of the imager, aqueductal CSF velocities of 3-5 mm/s were calculated. Cardiac-gated phase MR is a potentially major tool for the investigation of the CSF circulation.