A handbook of the theory and practice of medicine / by Frederick T. Roberts.

  • Frederick Thomas Roberts
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of the theory and practice of medicine / by Frederick T. Roberts. Source: Wellcome Collection.

    940/1006 (page 920)
    in which muscular weakness and rigidity advance together, the rigidity being usually in excess. Moreover, secondary degeneration is generally much more rapid in its progress; but when very chronic, its symptoms are exceedingly like those of ])rimary lateral sclerosis. As regards the brain, there is seldom much difficulty in diagnosis, there being hemiplegia and other characteristic symptoms, to which a condition of spastic hemiplegia is added. There are exceptional cases in which difficulty may arise, from the fact that the phenomena may be unilateral in connection with disease of the spinal cord, and thus a cerebral lesion may be simulated. In cerebral cases, however, there is generally a distinct history of the original lesion ; brain-symptoms are usually present; the face and tongue are commonly involved; rigidity and paralysis are more marked in the arms; sensation is unaffected, or anaesthesia, if present, is on the same side as the motor paralysis; and superficial reflexes are diminished or abolished. VI. Disseminated or Multiple Sclerosis. Pathology.—The form of sclerosis thus denominated is also known by various other names, such as insular sclerosis (Moxon), muliilocular sclerosis, sclerose en plaques disseminees (Charcot). It is characterized anatomically by the morbid condition being arranged in small roundish patches or nodules, scattered irregularly through the nerve-centres, and sometimes involving also the peripheral nerves. They may be found in different parts of the brain or spinal cord, either separately or together, often occupying several regions at the same time. According to the distribution of the nodules in the nerve-centres, disseminated sclerosis has been divided into three main types, namely:—i. Spitial; 2. Cerebral; 3. Cerebral-spinal, the last being the most common. In the cerebrum the nodules are seen chiefly in the corpus callosum, corpora striata, optic thalami, and septum lucidum ; sometimes in the centrum ovale; very rarely in the grey matter of the convolutions. The corpus dentatum is almost the only part of the cerebellum which is involved. Sclerotic patches may also be found in the pons or medulla. In the spinal cord their distribution is extremely irregular. They are said to be mainly con- fined to the white column, but may involve the grey matter; and are usually indiscriminate, though sometimes symmetrical. The ner\^es may be studded with patches, or diseased throughout. The nodules are in most cases well-defined, and either project above the surrounding level, or are depressed. Charcot states that they may usually be divided into three zones, indicating successive phases of the disease, the innennost zone being most advanced. They vary in size from a pin's head to a bean or larger : and also considerably in number in different cases. They have a grey translucent appearance, and on exposure to air assume a pink colour. Patches of sclerosis rarely lead to secondar}' degenerations, either ascending or descending. Symptoms.—It will be readily understood that the precise clinical history of disseminated sclerosis must be verv variable in different cases, and the symptoms are often exceedingly complex. Charcot aptly calls the polymorp/ious. Its invasion is usually extremely gradual and chronic, but occasionally is more or less abrupt or sudden. The reason that any definite clinical history of multiple sclerosis can be given at all is, that it very frequently involves the lateral columns of the cord, the medulla,