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Charles M. Poser, MD, FRCP

Arch Neurol. 2000;57:1074-1077.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

The fact that an alteration of the BBB is an important step in the formation of the MS lesion has been demonstrated many times by serial magnetic resonance imaging (MRI) studies.^2-7 Pozzilli et al⁸ reached the same conclusion from positron emission tomography studies. In 1986, I proposed that this alteration in permeability . . . [Full Text of this Article]

From the Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.

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