Several reports have been published of gliomas, especially medulloblastomas, metastasizing into the subrachnoid space (cf. Cairns & Russell 1931), and subarachnoid dissemination of papillomas of the choroid plexus is not uncommon. Among 80 odd published case reports of papilloma of the choroid plexus Herren, in 1941, found secondaries in the cerebro-spinal fluid in no less than one fifth. As these tumours have their site in the ventricular system, it is not unnatural that they should spread in the subarachnoid space.Subarachnoid dissemination from primary intracranial tumours, therefore, is not of uncommon occurrence, but extracranial metastases from primary brain tumours are extremely rare. Evidently, the conditions of growth in the central nervous system must be of quite a particular nature (cf. Christensen, K i z r & Winblad 1949). The extreme rarity of such metastases is apparent inter alia from a statement which according to Bodechtel & Schiiler (1937) was made at a Pathologists' Congress in 1935 : "Gliommetastasen in andere Korperorgane gibt es nicht, Liyuormetastasen dagegen sind bei Gliomen ein relativ haufiges Ereignis." This statement does not, however, hold good. As early as 1936 Nelson published a case of cerebellar medulloblastoma with metastases in the bodies of the lowest thoracic vertebrz. Searching the literature of the preceding 10 years he found 7 additional cases of metastasizing intracranial tumours. Six of these growths had been examined histologically, but their nature could not be decided with certainty in all cases. Nelson also pointed out that there were a few older reports of distant metastases of intracranial tumours, but the latter were not sufficiently elucidated to be grouped in the present detailed classification of intracranial tumours. 20*

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Now and then, one may encounter morbid processes which for long periods give rise to relatively few and slight clinical manifestations. Nevertheless, such morbid changes, like those occurring in the case to he reported helow, inay he so essential to the understanding of the disease as a whole that they should be reported whenever occasion arises. C A S E R E P O R lA.M. 0. A female, aged 65, who on the whole had heen in good health until 1949, when she was treated in Surgical Clinic C of the University Hospital, Copenhagen, for exostosis of the ulna and humerus. X-ray a t that time showed a dense calcareous shadow of irregular shape extending from the upper part of the o1ecranon.-The exostosis was chiselled off, and microscopical examination of the operative specimen showed spongy hony tissue with a rather fatty and vascular bone marrow. On the surface, there was a transition to a cartilaginous tissue poor in cells and fihrous connective tissue. No signs of inflammation or malignancy. Histological diagnosis: Exostosis.After that time, she did not exhihit any particular symptoms until Fehruary 1952 when she fainted in the street and was brought unconscious to one of the medical departments of Kommunehospitalet. Right-sided hemiparesis and hilateral Habinski were present. Pulse rate 60 of the perpetual arhythmia type. Systolic blood pressure 145. Spinal fluid: 1 lymphocyte/cu.mm, about 400 crythrocytes!cu.mm. 100 mg% total proteins. Eyes : Normal disks. Slight hppertensive vascular changes. No hzmorrhages or exudates.-On the next day the patient woke up, hut she was disorientated for time and place. At the end of four days, she was transferred tn the Department of Neurology; a t that time she had again lost consciousness, and the respiration was snoring, of thc Cheyne-Stokes type. She exhibited central paresis of the left facial nerve and paresis of the left arm, whereas the right arm moved spontaneously, hut weakly. Only slightly reduced power in the left lower limh. No definite difference hetween the strength of the tendon reflexes, hut typical left-sided and intermittent right-sided extensor response.-During the following days the condition fluctuated, and soon dysphagia and incontinence supervened.--Electrocardiograph.\-revealed auricular flutter. The blood pressure fluctuated Iietmecn 180/80 and 120/70. W.R. negative. IIrine normal. Blood urea 90 mg%.

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