The assessment of visuo-spatial neglect after acute stroke.

Forty four consecutive patients with acute hemispheric stroke and forty seven elderly controls with no neurological disease were assessed for visuo-spatial neglect, using a modified neglect test battery. Neglect was found to be equally common in patients with right hemisphere and left hemisphere stroke three days after stroke (72% versus 62%). It was more severe in those with a right hemisphere stroke and resolved more frequently in those with a left hemisphere stroke. The battery was validated against an occupational therapist's assessment of neglect on self-care tasks. The inter-observer reliability was good and it was possible to monitor changes over time with the battery.

Diphtheritic polyneuritis in an elderly woman: clinical and neurophysiological follow-up.

A 71-year-old English lady initially presented with a bulbar paralysis and, six weeks later, developed a generalised sensori-motor neuropathy. Corynebacterium diphtheriae mitis was cultured from her throat swab. Despite a good clinical recovery at one month, nerve conduction velocity was at its lowest. As far as the authors are aware, this is one of the few cases of neurophysiological and clinical follow-up in a British subject with diphtheritic peripheral neuropathy. This case emphasises the importance of giving antitoxin early.

Cyclosporin neurotoxicity in cardiac transplant recipients.

Cyclosporin toxicity may produce a wide range of neurological disorders. We report three patients whose neurological problems developed while taking cyclosporin following cardiac transplantation, but resolved rapidly when the drug was discontinued. In two cases, MRI revealed abnormalities which disappeared with clinical recovery. Blood cyclosporin concentrations were not markedly increased, and it is possible that the neurotoxic effects of cyclosporin are mediated by metabolites, through an effect on the blood-brain barrier.

Antibodies against the paramyxovirus SV5 in the cerebrospinal fluids of some multiple sclerosis patients.

Multiple sclerosis is a demyelinating disease of the central nervous system and although there is little doubt that an infectious agent (or agents) is involved it has not been possible to demonstrate this unequivocally by any direct relationship to a given agent. Here we show that a significant proportion of patients with multiple sclerosis have antibodies against the paramyxovirus SV5 (simian virus 5) in their cerebrospinal fluid and in some of these such antibodies form a major proportion of the total immunoglobulin content. Further, we have been able to demonstrate that the oligoclonal bands displayed on electrophoresis of the cerebrospinal fluid of these patients can be removed by prior absorption with SV5 virus antigen.

A neutralising monoclonal antibody against a paramyxovirus reacts with a brain antigen.

A monoclonal antibody against simian virus (SV5) HN glycoprotein which specifically neutralises the virus cross-reacts in immunofluorescence with an antigen in the cytoplasm of Purkinje cells of adult rat brain. After fixation in acetic acid-ethanol a cross-reaction is also seen with a myelin component. Cross-reaction of this antibody with human brain was also observed on section using immunofluorescence and in tissue extracts using ELISA and radioimmune assays. Monoclonal antibodies against other viruses, against another epitope on the same virus polypeptide and against another SV5 polypeptide of the same isotype were all negative in these tests.

Evidence for the persistence of paramyxoviruses in human bone marrows.

Human bone marrow cells derived from multiple sclerosis (MS) and control patients were screened for a number of virus antigens by the fluorescent antibody technique using monoclonal antibodies. The results showed that antigens of the paramyxovirus, simian virus 5, were present in about 60% of MS and 25% of control bone marrows. About 25% of the MS and 50% of control bone marrows were found to contain nucleoprotein antigen of the human parainfluenza types 1 and 3. These experiments demonstrated that paramyxoviruses can persist in human tissues possibly in a defective or repressed state.

Does simian virus 5 infect humans?

Simian virus 5 (SV5) isolates derived after co-cultivation of human bone marrow aspirates of multiple sclerosis (MS) patients were shown by immunoprecipitation, cross-neutralization and haemagglutination inhibition techniques to be similar antigenically but not identical to the prototype strain. Analyses of human sera (MS and control) showed that about 20% contained neutralizing antibodies to SV5 and immunoprecipitated the specific SV5 HN polypeptide. A competition assay using a specific SV5 monoclonal antibody confirmed that a human serum containing such neutralizing activity also blocked a specific SV5 epitope whereas another human serum with demonstrable antibodies to the related human parainfluenza virus type 2 did not block this epitope. These tests therefore suggested that SV5 can infect humans. However, there was no indication, on the basis of these tests, of any aetiological relationship of the SV5 infection to the induction of MS.

Isolation of an infectious agent from bone-marrows of patients with multiple sclerosis.

Bone-marrow aspirates from 5 patients with recent episodes of multiple sclerosis (M.S.) contained increased numbers of plasma cells, and aspirates from 3 of these patients contained atypical reticulum cells. When bone-marrow from 4 of the patients was inoculated into cell cultures a cytopathic effect (C.P.E.) was observed, and this effect could be serially passaged to further cultures. The C.P.E. was not observed when ether-treated extracts of cells showing C.P.E. were used for passage or when the passage material was filtered through a 100 nm filter. Appearance of C.P.E. was delayed in cultures inoculated with 220 nm filtrates of inoculum was passed through filters of greater pore size. No C.P.E. was observed after culture of bone-marrow aspirated from each of 7 patients under clinical investigation for disorders other than M.S.

Guillain-Barré syndrome after rubella.

A case of polyneuropathy (Guillain--Barré syndrome) developing only 6 days after rubella infection in a 26-year-old woman is described. Serological confirmation of the viral infection by detecting the specific IgM antibody has not been previously reported in any of the rubella cases associated with the syndrome.

Small-bowel abnormalities in multiple sclerosis.

Jejunal biopsies were performed in 12 randomly chosen patients with multiple sclerosis. The jejunal mucosa was examined histologically, ultrastructurally, and by tissue immune techniques. Histology showed a normal mucosa in 7 patients, increased inflammatory-cell infiltration in 3, a partial villous atrophy in 1, and a subtotal villous atrophy in the remaining patient. Fine structural abnormalities were seen in 6 of 8 patients studied. These included microvillous changes, increase in theliolymphocytes and epithelial lysosomes, thickening of the connective tissue with or without collagen fibres, and numerous macrophages containing large amounts of membrane-bound electron-dense material. The latter was seen in 5 of the 8 mucosae examined.