Case of paralysed person Flashcards
definition of MS?
chronic immune mediated CNS disease
how many people is MS affecting?
2 million
who does MS usually affect?
female predominance age 20-40
increased risk association with MS?
low vit D/ exposure UVB
EBV infection in past
obesity/ smoking
HLA DRB1
HLA-A
pathology of MS?
multifocal neuroinflammation plaques in white matter peri venular , subcortical and grey matter
molecular level of MS?
infiltrating lymphocytes mainly T cells,
axon degeneration gliosis and oligodendrocyte damage
how is MS first triggered
peripheral t cells become reactive, cross reactivity foreign antigens to CNS antigens carried in lymphatic system.
Activate macrophages and glia
how would a MS brain look macroscopically?
white matter loss- corpus callosum
hydrocephalus
volume loss global atrophy
what happens to bbb?
vasoactive molecules make the brain more leaky
what happens after some time?
remyelination via the oligodendrocyte precursor cells by myelin is thinner
how does GM to WM differ
GM lesions have less b/t cells or macrophage, seeding of inflammatory cells
what causes MS damage?
inflammatory demyelination (new T2 lesions/ or clinical relapse) and progressive neurodegeneration(atrophy/disability markers worsen irrespective of relapse activity)
scale for MS to assess mobility?
expanded disability status scale
SPMS?
less relapse favour progression but new plaques on MRI
PIRA>6-12 months
e
IFNbeta siponimod
PPMS?
predominant progression from onset
typically spastic paraparesis or sensory cereballar ataxia
radiologically isolated syndrome?
MRI abnormaties without clinical signs
40% will develop MS
Clinically isolated syndrome
symptoms lasting more than a day, demyelination optic neuritic
what is macdonald criteria?
s
how to diagnose MS?
at least 1 clinical relapse corresponding to one demyelinating MRI lesion
differential diagnosis of MS?
ADEM, NMOSD, sarcoidosis,SLE
what can you find in MS investigations?
oligoclonal bands positive
LMN signs
weakness, reduced reflexes, reduced tone flaccidity
UMN signs
increased brisk reflexes, increased tone,
where does the cell body of lmn sit?
anterior horn of grey matter
upper motor neurons cause?
paraplegia
if lmn lesion ask?
is sensation affected
if sensation is normal then?
NMJ, muscle
if sensation is abnormal then?
root, nerve, neuropathy
upper motor lesion investigation?
mri
if NMJ and muscle affected?
check for Myasthenia gravis and electrodes
in spinal cord lesion what is affected?
flaccidity/ hypotonia at that level- LMN
upper motor neurons - weakness spasticity distal to the lesion
T1 vs T2?
fluid is bright on T2, and black on T1
demyelination on MRI is?
white matter lesions typically
biomarkers of acute neuroinflammation?
t1 lesions with contrast enhancement
ring enhancing lesion on MRI could indicate?
brain abscess
what can you see in MS?
perpendicular lesions to ventricles, discrete (can draw around)
spinal cord lesions are usually?
dorsal, lateral eccentric
what is a precursor of MS?
transverse myelitis
tumefactive MS?
incomplete ring, peripheral enhancement
acute disseminated encephalomyelitis?
multiple lesions all over, patient very sick flu like illness
neuromyelitis optica?
demyeliniation long spinal cord lesion affects optic nerve too
MS differentials?
aging- a white dot per decade is normal
vascular- fluffy
ms- dorsal fingers
