58 STUDIES ON THE CENTRAL NERVOUS SYSTEM 



A female patient with sclerosis multiplex never showed 

 disturbances in the motility of the cranial nerves, except 

 a slight paresis of the left facial nerve. Speech was, how- 

 ever, almost impossible. The microscopic examination 

 showed that the brainstem was richly provided with sclerotic 

 areas, not only in the nuclei of the cranial nerves, but also 

 in their roots (fig. IQ). It is not strange, one may say, that 

 the cranial nerves did not show clinically more paresis, 

 since the axis cylinders are spared in the sclerotic areas, so 

 that the stimuli can pass. That is so, but why could not 

 the patient speak? 



A second example is the following. It is a regular and 

 early symptom of disseminated sclerosis, that the abdominal- 

 reflexes disappear. In sixty cases of our clinic fifty-four 

 showed changes of the abdominal reflexes. Does the fact, 

 that this reflex is partly connected with the forebrain and 

 that the communicating fibres are interrupted, explain this? 

 The arc of the knee reflex also communicates with the fore- 

 brain. Why then does this latter reflex not disappear with 

 the same regularity as the abdominal reflex, seeing that 

 sclerotic areas are so often present in the lumbar part of the 

 spinal cord? 



Nystagmus is a third example. This is a very frequent 

 symptom in sclerosis multiplex; it was present in 37 of 60 

 cases in our clinic. Anatomical research can usually ex- 

 plain the existence of such a nystagmus, because there are 

 many foci in the medulla oblongata. But why is this 

 nystagmus so often exclusively horizontal? And wh}^ do 

 these sclerotic areas so seldom cause a lasting palsy of the 

 sixth or seventh nerves, although anatomically there are so 

 many opportunities for this occurring? 



In this connection I further call your attention to the 

 frequent appearance of spastic paresis in the legs, which in 

 this disease often shows some peculiarity. This paresis is 

 often accompanied by a shght disturbance of the coordina- 

 tion. This does not occur in other cases of spastic paresis. 



