In 1982, I was asked by a general practitioner to urgently see a 72-year-old man who earlier that day had tried to break down a door at the back of his house in order to escape a perceived intrusion by armed men. It was our habit then to see most new psychiatric referrals at home typically accompanied by medical students who enjoyed escaping the hospital for a ride in my car. His wife told me that her husband had not been himself since retirement from a manual job 5 years earlier. Never a talkative man, he had become increasingly quiet and withdrawn with little interest in his garden or other activities. He had also become physically slower and spent several hours a day sleeping in his chair if left undisturbed. His wife wondered if he was depressed, but since he made no complaints and his mood did not seem low, they sought no help at that stage .For the last year, he had started to have episodes of confusion in which he appeared not to be fully orientated and spoke about seeing people in his house when his wife was clear that nobody was there. In between these episodes, he was more forgetful than previously although this was variable and at times he seemed almost his normal self. Over the last 2 months, he had repeatedly talked about seeing soldiers hiding in the rosebushes in his garden. These frightened him, and it was in response to thinking that they were about to come into his house and shoot him and his wife that he made the escape attempt that led to my visit.

Extracellular vesicles are recently described as specialized structures for intercellular communication. Their role in the central nervous system was diffusely studied in both physiological and pathological condition. In particular, an increased extracellular vesicle number was detected in several autoimmune diseases, including multiple sclerosis, a chronic autoimmune, inflammatory, demyelinating and neurodegenerative disease. This chapter summarizes the available information on the involvement of the extracellular vesicles in multiple sclerosis pathogenesis and their possible use as biomarker of therapy effcacy.

A multiple-choice-questions book is not only meant to test the knowledge but also serve as a concise guide for revision. It should also be able to help save time acquiring the vast amount of knowledge from books. The purpose of writing Multiple Choice Questions in Pain Management is to provide the relevant information in an interesting format. There are exit examinations all over the world after the pain fellowships for which there is no book available. This book also fills this gap for the trainees who are taking MCQ-based examination in the speciality. This volume is divided into ten chapters. The chapters provide a systemic approach to chronic pain starting from anatomy and physiology to the complexities of specialised pain. The book starts with a chapter on basic considerations which is one of the most complex topics to understand. This is followed by the process of evaluation and pharmacological management especially the mechanisms involved. The book then discusses in detail the two main divisions of pain, somatic and neuropathic pain. The book further discusses specialised areas of pain like visceral pain, cancer pain and head and neck pain. The chapter on miscellaneous questions delves into specialised groups like pregnant population, paediatric population and elderly population. Effort has been made to frame questions based on evidence available in the literature. The highlighting feature of the book is detailed answers explaining the complex information in a format which is easy to grasp. The book is not intended just to be a MCQ book but a concise pocket book explaining relevant concepts. It is meant for trainees but will serve an equal purpose for specialists who want to freshen their knowledge.