An illustrated pocketbook of multiple sclerosis by Charles M. Poser

By Charles M. Poser

This illustrated pocketbook provides an simply available precis of key matters with regards to diagnosing a number of sclerosis and coping with sufferers at diverse levels of the disease.

summary: This illustrated pocketbook provides an simply obtainable precis of key matters when it comes to diagnosing a number of sclerosis and handling sufferers at various phases of the ailment

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The myelin sheath is interrupted at regular intervals by nodes of Ranvier, where the axon is denuded. Because the axon has a high resistance to the electrical impulse and the speed of conduction is too slow, there is an alternative mechanism called ‘saltatory conduction’. This is where the electrical impulse jumps from one node of Ranvier to the next, while achieving the required conduction velocity. However, if the distance between the available nodes is too great because of destruction of myelin segments, the impulse cannot bridge the gap and saltatory conduction is either impaired or abolished.

These areas may be relatively large and may occupy a good part of the centrum semiovale. The clinical course of Balo’s disease is usually one of rapid progression. However, similar areas of concentric alternating demyelination have been seen in otherwise unremarkable cases of MS and in acute disseminated encephalomyelitis. Another variant of MS is diffuse sclero sis, or Schilder’s disease. True Schilder’s disease is extremely rare, and is defined as the presence of very large bilateral, slightly asymmetrical areas of demyelination in the cerebral white matter (Figures 20 and 21).

The basal ganglia, thalamus and hypothalamus, and dentate nuclei may also be sites of lesions. In exceptional circumstances, peripheral nerves may become involved. In regard to cranial nerves, lesions of the sensory nuclei of the trigeminal nerve, the intra-parenchymal portion of the facial nerve and connections of the acoustic nerves are not uncommonly encountered. Tic douloureux, or trigeminal neuralgia, in a subject of less than 40 years of age, is virtually pathognomonic of MS. Certain unusual forms of MS have been recognized, mostly on the basis of their pathological appearance.

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