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November 1980

Multiple Sclerosis and Cranial Lesions

Arch Neurol. 1980;37(11):738. doi:10.1001/archneur.1980.00500600086025

To the Editor.—  The recent case of multiple sclerosis reported by Morariu et al (Archives 1980; 137:189-190) brings to approximately 42 the number of patients with multiple sclerosis who have been shown to have lesions by contrast-enhanced cranial computerized tomography (CT).1 These patients range in age from 14 to 59 years, and most have had multiple sclerosis best described as acute, active, or exacerbating, although a few patients had clinically stable disease at the time of the cranial CT study.The lesions seen on contrastenhanced cranial CT represent areas of active demyelination histologically2,3 (the case of Davis et al4 had histologic confirmation) and result from extravasation of contrast medium across a defective blood-brain barrier.1 The delayed contrast enhancement noted by Morariu et al and the better visualization of contrastenhanced lesions, plus the appearance of more lesions with high-dose contrast enhancement as noted by Davis et al