Spinal Cord Injury and its Relationship to the Development or Worsening of Clinical Multiple Sclerosis

Publisher Summary This chapter highlights the clinical features noted by distinguished physicians of the occurrence of clinical multiple sclerosis (MS) or its exacerbation following trauma, particularly of the cervical cord. Multiple sclerosis is one of the most common causes of chronic neurologic disease in young adults. It has long been pointed out by a number of investigators that the plaques of MS bear a special relationship to blood vessels. Doring was one of the first to voice the opinion that the plaques, which are found adjacent to the lateral ventricles, also have a specific relationship to blood vessels. These early investigators also drew attention to the fact that the small blood vessels within plaques may or may not have inflammatory cells, but virtually all active plaques will have macrophages. Dawson, one of the first serious students of MS, showed that there was a clear relationship between the development of plaques and blood vessels. The proximity of the plaque to the ventricular system and the fact that it has a central vein or venule has led many investigators to speculate about the possibility of a pathogenic agent, such as an enzyme or immunoagent, that diffuses from the cerebrospinal fluid (CSF) or blood into the brain. All investigators of MS have come to the same conclusion that the plaque is based around small blood vessels, usually venules.