Case of paralysed person

Question 1

definition of MS?

Answer 1

chronic immune mediated CNS disease

Question 2

how many people is MS affecting?

Answer 2

2 million

Question 3

who does MS usually affect?

Answer 3

female predominance age 20-40

Question 4

increased risk association with MS?

Answer 4

low vit D/ exposure UVB
EBV infection in past
obesity/ smoking
HLA DRB1
HLA-A

Question 5

pathology of MS?

Answer 5

multifocal neuroinflammation plaques in white matter peri venular , subcortical and grey matter

Question 6

molecular level of MS?

Answer 6

infiltrating lymphocytes mainly T cells,
axon degeneration gliosis and oligodendrocyte damage

Question 7

how is MS first triggered

Answer 7

peripheral t cells become reactive, cross reactivity foreign antigens to CNS antigens carried in lymphatic system.
Activate macrophages and glia

Question 8

how would a MS brain look macroscopically?

Answer 8

white matter loss- corpus callosum
hydrocephalus
volume loss global atrophy

Question 9

what happens to bbb?

Answer 9

vasoactive molecules make the brain more leaky

Question 10

what happens after some time?

Answer 10

remyelination via the oligodendrocyte precursor cells by myelin is thinner

Question 11

how does GM to WM differ

Answer 11

GM lesions have less b/t cells or macrophage, seeding of inflammatory cells

Question 12

what causes MS damage?

Answer 12

inflammatory demyelination (new T2 lesions/ or clinical relapse) and progressive neurodegeneration(atrophy/disability markers worsen irrespective of relapse activity)

Question 13

scale for MS to assess mobility?

Answer 13

expanded disability status scale

Question 14

SPMS?

Answer 14

less relapse favour progression but new plaques on MRI
PIRA>6-12 months

Question 15

e

Answer 15

IFNbeta siponimod

Question 16

PPMS?

Answer 16

predominant progression from onset
typically spastic paraparesis or sensory cereballar ataxia

Question 17

radiologically isolated syndrome?

Answer 17

MRI abnormaties without clinical signs
40% will develop MS

Question 18

Clinically isolated syndrome

Answer 18

symptoms lasting more than a day, demyelination optic neuritic

Question 19

what is macdonald criteria?

Answer 19

s

Question 20

how to diagnose MS?

Answer 20

at least 1 clinical relapse corresponding to one demyelinating MRI lesion

Question 21

differential diagnosis of MS?

Answer 21

ADEM, NMOSD, sarcoidosis,SLE

Question 22

what can you find in MS investigations?

Answer 22

oligoclonal bands positive

Question 23

LMN signs

Answer 23

weakness, reduced reflexes, reduced tone flaccidity

Question 24

UMN signs

Answer 24

increased brisk reflexes, increased tone,

Question 25

where does the cell body of lmn sit?

Answer 25

anterior horn of grey matter

Question 26

upper motor neurons cause?

Answer 26

paraplegia

Question 27

if lmn lesion ask?

Answer 27

is sensation affected

Question 28

if sensation is normal then?

Answer 28

NMJ, muscle

Question 29

if sensation is abnormal then?

Answer 29

root, nerve, neuropathy

Question 30

upper motor lesion investigation?

Answer 30

mri

Question 31

if NMJ and muscle affected?

Answer 31

check for Myasthenia gravis and electrodes

Question 32

in spinal cord lesion what is affected?

Answer 32

flaccidity/ hypotonia at that level- LMN upper motor neurons - weakness spasticity distal to the lesion

Question 33

T1 vs T2?

Answer 33

fluid is bright on T2, and black on T1

Question 34

demyelination on MRI is?

Answer 34

white matter lesions typically

Question 35

biomarkers of acute neuroinflammation?

Answer 35

t1 lesions with contrast enhancement

Question 36

ring enhancing lesion on MRI could indicate?

Answer 36

brain abscess

Question 37

what can you see in MS?

Answer 37

perpendicular lesions to ventricles, discrete (can draw around)

Question 38

spinal cord lesions are usually?

Answer 38

dorsal, lateral eccentric

Question 39

what is a precursor of MS?

Answer 39

transverse myelitis

Question 40

tumefactive MS?

Answer 40

incomplete ring, peripheral enhancement

Question 41

acute disseminated encephalomyelitis?

Answer 41

multiple lesions all over, patient very sick flu like illness

Question 42

neuromyelitis optica?

Answer 42

demyeliniation long spinal cord lesion affects optic nerve too

Question 43

MS differentials?

Answer 43

aging- a white dot per decade is normal vascular- fluffy ms- dorsal fingers