IN SOME patients with multiple sclerosis (MS), certain kinds of trauma may act as a trigger at some time for the appearance of new or recurrent symptoms. Only trauma affecting the head, neck, or upper back, that is, to the brain and/or spinal cord, can be considered significant.1 This premise is based on the twin considerations that an alteration of the blood-brain barrier (BBB) is an obligatory step in the pathogenesis of the MS lesion and that trauma to the central nervous system (CNS) can result in such a loss of BBB impermeability.
Magnetic resonance images of the cervical spine of 3 patients with clinically definite multiple sclerosis (MS) without a history of external trauma. The arrows indicate the MS lesions. Parts A and C are reprinted with permission from Parthenon Publishing Group Inc (Poser22).
Magnetic resonance images of the cervical spine of a patient with clinically definite multiple sclerosis 14 months after whiplash injury. Neck flexion (A and B) further decreases the anterior subarachnoid space at the C4-5, C5-6, and C6-7 levels. This degree of voluntary flexion cannot fully reproduce the effect of the violent hyperflexion of a whiplash injury. The lesion at the level of C3 appears to be due to compression of a fold of the posterior ligament. Reprinted with permission from Parthenon Publishing Group Inc (Poser22).
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