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Distribution of plaques in the cerebrum in multiple sclerosis
Authors: Brownell B, Hughes JTYear Published: 1962Number of times cited: 590
Published 58 years ago this seminal work from Oxford has been cited nearly 600 times. What did it describe and why is it considered so important?
Multiple sclerosis (MS) remains an enigmatic disease (or syndrome), reluctant to give up its secrets: visualised on MRI, an inflammatory vapour trail in the cerebrospinal fluid, characteristic in its clinical manifestations and now partially responsive to therapeutic intervention. However, the exact causality (genetic/environmental) remains hidden behind the curtain. One way to try to coax it onto the stage is neuropathology, where the ‘caught in the act’ actors are captured and their ruinous works see light—even though of course, they are frozen from the time of death and represent the accumulated sacking of the central nervous system over many decades.
The highly cited JNNP article by Brownell and Hughes1 commences by describing the quandary faced in the middle of the 20th century with MS neuropathology. Although the literature was immense,2 there was no work which mapped out the ‘position of the plaques in the cerebrum with any exactitude’, though a spinal cord study of eight cases found spinal plaques with some regional consistency.3 The task set here was to ‘determine with some precision the position and relative frequency of plaques seen macroscopically in the cerebral hemispheres’. The underlying manifesto of course was that this could shine some light on the secrets of the disease process.
The experimental stage chosen was 22 unselected MS cases (the clinical details were not given) accumulated from 1958 to 1961. The fixed hemispheres were cut coronally at 1 cm intervals (the first cut in front of the mammillary bodies) and the slices photographed in life-size prints. On the prints, each plaque …
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