302 Clinical approaches to motor weakness Flashcards
What is multiple scleorosis?
A chronic immune-mediated central nervous system disease
What is multiple scleorosis?
Multifocal, autoimmune, neuroinflammation plaques within the white matter and subcortical and grey matter
It’s mediated by infiltrating T and B cells
Results in oligodendrocyte damage (demyelination) and axon degeneration (axonopathy and gliosis
More common in women
Manifests at 20-40 years
What are the risks for multiple sclerosis?
lower vitamin D/UVB exposure
Smoking
Obesity
Past EVB infection
Genetics
What does an MS brain look like?
Global atrophy
Hydrocephalus ex vacuo
Thinned corpus collosum
Extensive demyelination
Describe the early and late stages of development of MS
Early active phase: florid myelin destruction with macrophages and axonal damage
Late phase: macrophages take in the myelin debris and contribute to axon loss
Where are MS lesions most likely to occur?
Near a vein because it’s all done by lymphocytes that travel in the blood stream
How does inflammation in MS appear when we can’t see it?
Even the healthy looking areas have:
-Reduced neurones, and synapses
-Oxidative stress
-Reduced axonal transport
-Diffuse microglial activation
What is believed to causes remission in MS?
There will be immune cells wanting to keep the inflammation under control and this will be effective but not for long
What are the 3 phases of MS?
Relapsing-remitting MS (RRMS)
-Symptoms get worse and then there is recovery
Secondary-progressive MS (SPMS)
-The MS gets progressively worse
Primary-progressive MS (PPMS)
What is radiologicall isolated syndrome?
MRI abnormalities found incidentally showing demyelination but without clinical signs of symptoms
What is clinically isolated syndrome?
A single clinical even typical for demyelination that lasts more than 24hrs
Not everybody goes on to develop MS
How to diagnose MS?
-1 clinical event corresponding to 1 demyelinating MRI lesion
Dissemination in time and space
There must not be any other explanation for the symptoms
What is the name of the criteria used to diagnose MS?
McDonald criteria
What are some differentials for MS?
-Other Idiopathic Inflammatory Demyelinating Disorders (IIDD) Acute Disseminated Encephalomyelitis (ADEM)
-Idiopathic Inflammatory Non-Demyelinating Diseases: Neuro-Behçet’s Disease
-Infectious Diseases: Lyme Disease
-Metabolic Disorders
How is MS relapse treated?
Steroids
Plasma exchange
They don’t treat but help speed up the relapse. Not every relapse needs to be treated
