Recent experimental work1 has made it seem probable that the lesions of multiple sclerosis and also those of the forms of "disseminated encephalomyelitis" which seem to represent a more acute stage of the same process2 are produced by a local circulatory disturbance, apparently of the nature of an obstruction on the venous side. According to this point of view, there must be a primary change in the contents of the vessels of the central nervous system, or possibly of the intimal lining, which leads to thrombosis of venules. This produces local passive congestion and a mild degenerative process which affects myelin sheaths more than other structures. The myelin degenerates and is phagocytosed. The "inflammatory" phenomena would then be regarded as secondary or symptomatic and the gliosis as reparative or reactive. This hypothesis obviously must remain largely a speculation as long as it rests on the results of experimentation
PUTNAM TJ. EVIDENCES OF VASCULAR OCCLUSION IN MULTIPLE SCLEROSIS AND "ENCEPHALOMYELITIS". Arch NeurPsych. 1937;37(6):1298–1321. doi:10.1001/archneurpsyc.1937.02260180078006
Customize your JAMA Network experience by selecting one or more topics from the list below.