Diffuse sclerosis (encephalitis periaxialis diffusa) / by L. Bouman ; with 64 illustrations.

  • Bouman, L. (Leendert), 1869-1936.
Date:
1934
Catalogue details

Licence: In copyright

Credit: Diffuse sclerosis (encephalitis periaxialis diffusa) / by L. Bouman ; with 64 illustrations. Source: Wellcome Collection.

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    our knowledge of it can be but slow ; many eases occurring in child¬ hood cannot for various reasons be verified post mortem. The examination may be omitted or not permitted, or the patient may have gone home to die. With some hesitation we must add that even at the post mortem now and then, the changes are not recognized and the case never reaches the neuropathologist. The latter, more¬ over, is too much accustomed to give his chief attention to the cortex, although in the last few years changes in the white matter have for reasons unconnected with our subject claimed more attention than before. The cortex in this condition is often fairly free from abnor¬ malities and the adjoining pia shows no important changes. So this we may say is really of only secondary importance. But a more serious difficulty is this : perhaps we are not talking about a single entity at all. Globus affirms that what we' are dealing with is a group of processes all leading to the same result—namely, the diffuse sclerosis of the white matter, and Weimann also says that the term ‘diffuse sclerosis of the brain’ covers many disease processes of types which the state of our knowledge will not let us differentiate as yet. Moreover, there are hereditary forms of the disease probably closely connected with the Pelizaeus-Merzbacher disease and with amaurotic idiocy. In separating this special hereditary group, it must be borne in mind that heredity also plays a part in disseminated sclerosis which occurs sometimes in uniovular twins, and also in the new groups of hereditary disseminated sclerosis described by Si lie vis Smitt and Smit.108 Sometimes we come across a case of diffuse sclerosis that runs a fairly rapid course, and then one running a chronic course. Some¬ times short remissions are observed. French writers have reported even long remissions and have mentioned the possibility of recovery. The various localizations are, of course, the cause of very varied symptoms. If we compare the first case described by Schilder with cases which I shall describe here, we shall find such important differ¬ ences that it is difficult to class them under the same head. And this first case, which the writer looks upon as being of inflammatory origin, which is considered by Neubiirger to be of degenerative origin, and is looked upon by Lewy as neoplastic, shows how many different anatomical views are possible. This can be explained by the fact that what one person calls an inflammation is looked upon by another as the result of a degenerative process, the lymphocyte infiltration being then regarded as a mere reaction of the type known as ‘ symptomatic5 inflammation. If we accept the criteria of Collier and Greenfield.32 we have the following symptomatic picture “ A maladv usually occurring in children and young subiects * » CD «. O t)