Clinical manifestations and MRI findings in four Japanese children with multiple sclerosis are reported from the Department of Pediatrics, Sapporo Medical University, Japan. Three presented with gait ataxia and one developed cerebellar intention tremor within 2 months of an onset with weakness of the right arm and speech impairment. The age of onset of symptoms was at 7-12 years. All had optic neuritis. MRI showed multiple white matter lesions and demyelinating plaques in cerebral hemispheres, cerebellum and brain stem. CT abnormalities were indefinite or absent. 
COMMENT. MRI was more sensitive than CT in diagnosis of demyelination in these patients. One of the 4 children had presented with Devic disease and 2 years later developed chronic inflammatory demyelinating polyradiculoneuropathy. A survey of 55 pediatric patients with MS in Japan by Prof Y Fukuyama and associates (1991) had found peripheral nerve involvement in 10 (17%).