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The most stunning galaxies, from the standpoint of the visual observer, are the spirals. Their variety is almost infinite. Some spirals appear broadside to us, some appear at a slant, and still others present themselves edgewise. The spiral arms can have many different shapes. There are two major types of spiral galaxies: the normal spiral and the barred spiral. There are subclassifications within these two major categories. These are rather subjective and must be judged based on what we see. It is easy to classify spirals when they present themselves nearly broadside to us but difficult when they present themselves edgewise or nearly edgewise. Normal spirals are classified S0, Sa, Sb, and Sc (Fig. 15-2) depending on how tightly their bands of stars are wound around the nucleus. The barred spirals are classified as S0, SBa, SBb, and SBc (Fig. 15-3). The S0 galaxies are shaped like oblate (flattened) spheres, or like donuts with golf balls stuck in their centers. Both the normal spirals and the barred spirals branch off from this common root type. These classifications, like the classifications for the elliptical galaxies, were devised by Hubble.

S, P, AND E (SUBSTRATE, PRODUCT, ENZYME)

by bacteria and should therefore be regarded as a noninfectious encephalopathy When macrophages and astrocytes are exposed to endotoxins in vitro, the cells synthesize and release cytokines, among which are interleukin-1 and tumor necrosis factor These cytokines are believed to stimulate and modulate the local immune response but may also affect cortical neurons In the early stages of meningitis, there is little change in the ependyma and the subependymal tissues; but in later stages, conspicuous changes are invariably found The most prominent nding is in ltration of the subependymal perivascular spaces and often of the adjacent brain tissue with neutrophilic leukocytes and later with lymphocytes and plasma cells Microglia and astrocytes proliferate, the latter sometimes overgrowing and burying remnants of the ependymal lining.

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The association of myxedema and cerebellar ataxia has been mentioned sporadically in medical writings since the latter part of the nineteenth century Interest in this problem was revived in more recent years by Jellinek and Kelly, who described 6 such cases All of them showed an ataxia of gait; in addition, some degree of ataxia of the arms and dysarthria were present in 4 instances, and nystagmus in 2 Cremer and coworkers have reported a similar clinical experience, based on a study of 24 patients with either primary or secondary hypothyroidism There have been only a few reports of the pathologic changes, and these are far from satisfactory.

The myxedematous patient described by Price and Netsky had also been a serious alcoholic, and the clinical signs (ataxia of gait and of the legs) and pathologic changes (loss of Purkinje cells and gliosis of the molecular layer, most pronounced in the vermis) could be distinguished from those due to alcoholism and malnutrition Scattered throughout the nervous system of their case were unusual glycogen-containing bodies, similar but not identical to corpora amylaceae These structures, designated myxedema bodies by Price and Netsky, were also observed in the cerebellar white matter of a second case of myxedema; there were no other neuropathologic changes, however, and this patient had shown no ataxia during life It is dif cult to know whether these peculiar bodies have anything to do with myxedema If they do, it should be possible to demonstrate them in more than two cases.

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We believe that the bacteria pass through the ependymal lining and set up this in ammatory reaction in part because this sequence of events is favored by a developing hydrocephalus, which stretches and breaks the ependymal lining Collections of subependymal astrocytes then begin to protrude into the ventricle, giving rise to a granular ependymitis, which, if prominent, may narrow and obstruct the aqueduct of Sylvius The choroid plexus is at rst congested, but within a few days it becomes in ltrated with neutrophils and lymphocytes and eventually may be covered with exudate As in the case of the meningeal exudate, lymphocytes, plasma cells, and macrophages later predominate Eventually there is organization of the exudate covering the plexus As any meningitis becomes more chronic, the pia-arachnoid exudate tends to accumulate around the base of the brain (basilar meningitis), obstructing the ow of CSF and giving rise to hydrocephalus.

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