Home >> Diseases Of Children >> Intestinal Bacteria to Neoplasms And Parasites Of >> Multiple Cerebral and Spinal

Multiple Cerebral and Spinal Sclerosis

anatomical, tissue, based, nervous, degeneration and schupfer

MULTIPLE CEREBRAL AND SPINAL SCLEROSIS Multiple cerebral and spinal sclerosis consists in the presence of numerous, dense, yellowish white foci in the spinal cord, medulla oblon gata and cerebrum. Microscopic examination reveals excessive pro liferation of the neuroglia, such as is not attained in any other central disease of the nervous system (Weigert). The nervous tissue itself shows very little change; Hie flXiS cylinders of the nerve fibres within the sclerotic patches are for the most part preserved and the ganglion cells are intact. Products of degeneration of nerve substance are found only around the foci. Secondary degeneration of nerve tracts is usually absent.

The above anatomical picture, which has recently been clearly definecl by Muller, is to be sharply distinguished from the proliferations of connective tissue which occur after disseminated encephalomy-elitis (secondary multiple sclerosis, Schmauss, Ziegler). "Multiple gliosis," as we may call multiple sclerosis on the strength of the anatomical findings, is probably attributable to some congenital condition of the neuroglia. The affection might be classified among the endogenous diseases except that it is not hereditary or familial. In View of the neoplastic, progressive character of the anatomic changes it seems more justifiable to include multiple sclerosis among the neoplasms of the nervous system.

If we accept Muller's theory in regard to genuine multiple sclerosis which WC have given above and which is explained in his comprehensive monograph, we must arrive at the very remarkable conclusion that this disease does not occur in childhood. Sehupfer in his essay on infantile focal sclerosis demonstrated that the cases which have been described in extraordinary- large numbers will not bear criticism. In fact, the very cases in which the triad formulated by Charcot as characteristic of multiple sclerosis, namely, intention tremor, scanning speech and nys tagmus, were present turned out, on pathologic examination, to be cases of pseudosclerosis, hereditary syphilis, endogenous degeneration, or cerebral infantile palsy. The very few cases—tlaree in number—which

Schupfer accepts as cases of multiple sclerosis presented chiefly dis turbances in the motor action of the legs (paraparesis, tremor), dis turbances of sensation, defective movements of the eyes, and weakness of the bladder. Hence a diagnosis of multiple sclerosis based on the above-mentioned characteristic triad is not justified in children. Muller even casts a doubt on the authenticity of the eases accepted by Schupfer. He is unable to find in any of these eases the positive signs of exclusive disease of the neurogliar tissue and regards these cases, including the one which Schupfer carefully- studied as a paradigm, EIS disseminated myeloencephalitis. He explains the alleged influence of infectious diseases in the production of multiple sclerosis in children and contends that the nervous effects which follow the infectious diseases are dissemi nated, chronic inflammations and not primary proliferation of neurogliar tissue or, in other words, multiple sclerosis. Under these circumstances Muller arrives at the conclusion that as yet there is no proof of the occurrence of fully developed infantile focal sclerosis identical with gen uine multiple sclerosis and that the cases which hitherto have been regarded as multiple sclerosis on the strength of the anatomical findings merely represent the terminal stages of disseminated encephalomyelitis.

Until this contention, which is based on accurate studies, shall be refuted by arguments based on anatomical findings of an opposite nature, we are not justified in making a diagnosis of multiple sclerosis in the child based on clinical symptoms and are therefore constrained to classify all the cases hitherto regarded as multiple sclerosis under some different head.