Granular ependymitis is distinct from the plaque, both in site (i.e.
sometimes distant from plaques), and also in time of onset (i.e. less associated
with lymphocytic infiltration and the early non-confluent perivenous lesion).
Granular ependymitis is not an early feature of the disease and is not specific
for multiple sclerosis; for example, it is seen in association with ventricular
dilatation or meningitis (see Results). Nevertheless. it does seem to provide a
possible route in multiple sclerosis for movement of inflammatory agents (e.g.
IgG and C3) between CNS lesion and CSF, or vice versa. This could explain
the 23% incidence of raised albumin in the CSF in multiple sclerosis (Walsh
& Tourtellotte, 1983), as well as the increase therein of myelin constituents,
such as basic myelin protein (Cuzner et al., 1978).
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