[Diagnosis of multiple sclerosis].

The author examined by direct opthalmoscopy in satisfactory mydriasis the fundus of a group of 100 patients with multiple sclerosis or suspected multiple sclerosis. In 13-18% of the patients whitish-grey sheathing of some retinal veins was found (Rucker's symptom) associated with the activity of the demyelinization process--twice as frequently in patients during the period of attack as in subjects in remission of the basic disease. The author differentiates sheathing at rest from the active form which he found only in patients with a fresh attack and which is documented by photographs. Atrophy of the optic disc was found in 23%, retrobulbar neuritis in the case-history of 27% of the subjects. In case of a marginal finding of incipient partial atrophy of the papilla attention is drawn to the subjective character of evaluation and the need of further examinations. The author discuss the pathological background of the finding of sheathing as a perivenous inflammatory infiltration in relation to similar changes in the CNS during demyelinisation. The finding of Rucker's symptom seems to be to a considerable extent pathognomic for multiple cerebrospinal sclerosis and may precede the initial neurological symptomatology.