Interpretation of Findings in Cerebrospinal Fluid: III. Syndrome of Multiple Sclerosis

Abstract

In the colloidal gold reaction, the so-called paretic curve, now designated as type D, was first thought to occur only in neurosyphilis, but later was found also in multiple sclerosis. In most clinics, however, findings in cerebrospinal fluid are considered of limited value as an aid in diagnosing multiple sclerosis. In the authors'' experience, many spinal fluid specimens from patients diagnosed clinically show no abnormality except in the gold reaction, which may be of weak degree. Because insensitive sols are widely used, most leading neurologists consider that not more than half the cases reveal changes in the spinal fluid. In some laboratories, sols are acidified to compensate for lack of sensitivity; in acid medium so many different protein patterns yield the type D (paretic) curve that its differential value is lost. With a sensitive sol in a standardized test, highly significant results in the examination of fluid from multiple sclerosis are obtained; only once, in a "burned out" case, has the spinal fluid from a proved case been found normal. The type D curve usually suggests multiple sclerosis when no reaction is obtained in serologic tests for syphilis in blood or spinal fluid and history of antisyphilitic treatment is lacking. An important exception is chronic encephalitis. A knowledge of the clinical history is essential in the differential diagnosis. The results obtained with the new quantitative methods suggest that progressing multiple sclerosis is a continuously active pathologic process involving parenchymatous degeneration, not a periodically recurring one, as the clinical remissions and relapses would suggest.