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the pharmacologic prophylaxis of post-traumatic epilepsy Neurology 29: 600, 1979 PEVEHOUSE BC, BLOM WH, MCKISSOCK KW: Ophthalmologic aspects of diagnosis and localization of subdural hematoma Neurology 10:1037, 1960 POLIN RS, SHAFFREY ME, BOGAEV CA, et al: Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema Neurosurgery 41:84, 1997 PUDENZ RH, SHELDON CH: The lucite calvarium Method for direct observation of the brain J Neurosurg 3:487, 1946 PURVIS JT: Craniocerebral injuries due to missiles and fragments, in Caveness WF, Walker AE (eds): Head Injury Philadelphia, Lippincott, 1966, pp 133 141 RABE EF, FLYNN RE, DODGE PR: A study of subdural effusions in an infant Neurology 12:79, 1962 RABE EF, YOUNG GF, DODGE PR: The distribution and fate of subdurally instilled human serum albumin in infants with subdural collections of uid Neurology 14:1020, 1964 RASMUSSEN T: Surgical therapy of post-traumatic epilepsy, in Walker AE, Caveness WF, Critchley M (eds): Late Effects of Head Injury Spring eld, IL, Charles C Thomas, 1969, pp 277 305 RISH BL, CAVENESS WR: Relation of prophylactic medication to the occurrence of early seizures following craniocerebral trauma J Neurosurg 38:155, 1973 ROBERTS AJ: Brain Damage in Boxers: A Study of Prevalence of Traumatic Encephalopathy among Ex-professional Boxers London, Pitman, 1969 ROBERTS GW, ALLSOP D, BRUTON C: The occult aftermath of boxing J Neurol Neurosurg Psychiatry 53:373, 1990 ROPPER AH, et al (eds): Neurological and Neurosurgical Intensive Care, 4th ed Baltimore, Lippincott Williams & Wilkins, 2004 ROPPER AH, MILLER D: Acute traumatic midbrain hemorrhage Ann Neurol 18:80, 1985 ROSNER MJ, BECKER DP: Origin and evolution of plateau waves J Neurosurg 60:312, 1984 ROSS RJ, COLE M, THOMPSON JS, KIM KH: Boxers Computed tomography, EEG, and neurological evaluation JAMA 249:211, 1983 ROSSITCH E JR, BULLARD DE: The autonomic dysfunction syndrome: Aetiology and treatment Br J Neurosurg 2:471, 1988 ROWBOTHAM GF (ed): Acute Injuries of the Head, 4th ed, Baltimore, Williams & Wilkins, 1964 RUSSELL WR: The Traumatic Amnesias London, Oxford, 1971 SAUL TG, DUCKER TB, SALCMAN M, CARRO E: Steroids in severe head.

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injury: A prospective randomized clinical trial J Neurosurg 54:596, 1981 SAZBON L, FUCHS C, COSTEFF H: Prognosis for recovery from prolonged posttraumatic unawareness: Logistic analysis J Neurol Neurosurg Psychiatry 54:149, 1991 SHANN F: Hypothermia for traumatic brain injury: How soon, how cold, and how long Lancet 362:1950, 2003 SHATSKY SA, EVANS DE, MILLER F, MARTINS AN: High speed angiography of experimental head injury J Neurosurg 41:523, 1974 SIMON B, LETOURNEAU P, VITORINO E, et al Pediatric head trauma: Indications for computed tomorgraphic scanning revisited J Trauma 51: 231, 2001 STERN WE: Carotid-cavernous stula, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology Vol 24 Amsterdam, North-Holland, 1975, pp 399 440 STRICH SJ: Diffuse degeneration of the cerebral white matter in severe dementia following head injury J Neurol Neurosurg Psychiatry 19:163, 1956 STRICH SJ: The pathology of severe head injury Lancet 2:443, 1961 SYMONDS CP: Concussion and its sequelae Lancet 1:1, 1962 SYMONDS CP: Concussion and contusion of the brain and their sequelae, in Feiring EH (ed): Brock s Injuries of the Brain and Spinal Cord and Their Coverings, 5th ed New York, Springer-Verlag, 1974, pp 100 161 TEASDALE G, JENNETT B: Assessment of coma and impaired consciousness: A practical scale Lancet 2:81, 1974 TEUBER H-L: Effects of brain wounds implicating right or left hemisphere in man, in Mountcastle VB (ed): Interhemispheric Relations and Cerebral Dominance Baltimore, Johns Hopkins University Press, 1962, pp 131 157 TROTTER W: Certain minor injuries of the brain Lancet 1:935, 1924 VOLLMER DG, TORNER JC, JANE JA, et al: Age and outcome following traumatic coma: Why do older patients fare worse J Neurosurg 75(Suppl):S37, 1991 WALKER AE: Post-traumatic epilepsy, in Rowbotham GF (ed): Acute Injuries of the Head, 4th ed, Baltimore, Williams & Wilkins, 1964, pp 486 509 WEIR B: The osmolality of subdural hematoma uid J Neurosurg 34:528, 1971 WEISS GH, SALAZAR AM, VANCE SC, et al: Predicting posttraumatic epilepsy in penetrating head injury Arch Neurol 43:771, 1986 ZANDER E, FOROGLOU G: Post-traumatic hydrocephalus, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology Vol 24 Amsterdam, North-Holland, 1976, pp 231 253.

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It has long been the practice to set apart a group of diseases of the brain and spinal cord in which destruction of myelin (demyelination) is a prominent feature To de ne these diseases precisely is dif cult, for the simple reason that there is probably no disease in which myelin destruction is the exclusive pathologic change The idea of a demyelinative disease is, more or less, an abstraction that serves primarily to focus attention on one of the more striking and distinctive features of one group of pathologic processes The commonly accepted pathologic criteria of a demyelinative disease are (1) destruction of the myelin sheaths of nerve bers with relative sparing of the other elements of nervous tissue, ie, of axons, nerve cells, and supporting structures, as re ected by a relative lack of wallerian or secondary degeneration of ber tracts; (2) in ltration of in ammatory cells in a perivascular and particularly paravenous distribution; (3) a distribution of lesions that is primarily in white matter, either in multiple small disseminated foci or in larger foci spreading from one or more centers A classi cation of the demyelinative diseases is presented in Table 36-1 The diseases included in this classi cation conform approximately to the criteria enumerated above Like all classi cations that are not based on etiology, this one has its shortcomings in that it is somewhat arbitrary In some of the diseases here classi ed as demyelinative, notably Schilder disease and necrotizing hemorrhagic leukoencephalitis and even multiple sclerosis, there can be a severe degree of damage to axis cylinders and vascular structures as well as to myelin Contrariwise, a number of diseases in which demyelination is a prominent feature are not included In some cases of anoxic encephalopathy, for example, the myelin sheaths of the radiating nerve bers in the deep layers of the cerebral cortex or in ill-de ned patches in the convolutional and cenTable 36-1 Classi cation of the demyelinative diseases I Multiple sclerosis (disseminated sclerosis) A Chronic relapsing encephalomyelopathic form B Acute multiple sclerosis C Diffuse cerebral sclerosis (Schilder disease and concentric sclerosis of Balo) II Neuromyelitis optica (Devic disease) III Acute disseminated encephalomyelitis A Postinfectious: following measles, chickenpox, smallpox, mumps, rubella, in uenza, and other viral and some bacterial infections (Mycoplasma, Rickettsia) B Following rabies or smallpox and rarely other types of vaccination (postvaccinal) IV Acute and subacute necrotizing hemorrhagic encephalitis A Acute encephalopathic form (Hurst hemorrhagic leukoencephalitis) B Subacute necrotic myelopathy 771.

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