INFLAMMATORY DEMYELINATING DISORDERS Flashcards
MYELIN IN CNS is Formed by
MYELIN in PNS is FORMED BY
⭐ OLIGODENDROCYTES
⭐ SCHWANN CELLS
Junction of MYELIN sheath of CNS and PNS is known as
OBERSTEINER-REDLICH ZONE
Junction of CNS and PNS
T ➕ B cell disorders
➕
Subacute to Chronic
➕
Autoimmune; ♀️ > ♂️
➕
OLIGODENDROCYTES and ASTROCYTES affected
INFLAMMATORY DEMYELINATING DISORDERS of CNS
DISRUPTION OF BLOOD BRAIN BARRIER by VEGF is seen in
INFLAMMATORY DEMYELINATING DISORDERS of CNS
VEGF A is produced by ASTROCYTES
⬇️
Injury to ENDOTHELIAL CELLS
ANTIBODY in INFLAMMATORY DEMYELINATING DISORDERS of CNS
anti-MOGP
(Myelin OLIGODENDROCYTE Glycoprotein)
INFLAMMATORY DEMYELINATING DISORDERS of CNS
- Multiple Sclerosis
- Neuromyelitis Optics Spectrum disorders
- ADEM : Acute Disseminated Encephalomyelitis
Diseases MIMICING: INFLAMMATORY DEMYELINATING DISORDERS of CNS
🧠⚡ S²CG⚡
- SLE
- Sarcoidosis
- Chronic GVHD
NON-INFLAMMATORY DEMYELINATING DISORDERS of CNS
Osmotic DEMYELINATION Syndrome
Central Pontine Myelinosis
CHARCOT’S TRIAD Seen in
⭐ NEUROLOGY 🧠⚡ SIN⚡
⭐ BILIARY 🧠⚡intermittent FJP ⚡
CHARCOT’S TRIAD OF MULTIPLE SCLEROSIS
S-staccato speech
I-intentional tremors
N-nystagmus
CHARCOT’S TRIAD in ACUTE CHOLANGITIS
✨ Fever
✨ Jaundice
✨ Pain
Chronic/ Subacute (3-4 wks)
➕
♀️, Young 20-40 yrs
➕
PAINFUL VISUAL LOSS
➕
Sensory > > Motor
➕
Paresthesia / Hypoesthesia / Unpleasant SENSATION
Multiple Sclerosis
Symptoms that Rule out MS
🧠⚡ DUNES HR⚡
- 8th Cranial Nerve Involvement ➡️ Deafness
- Peripheral Neuropathy
- Uveitis, Sclera Involvement
- Retinal involvement
- Severe HIGHER Mental Function Involved
- Encephalopathy
Multiple Sclerosis involves
- Cortical
- Subcortical
- Brainstem
- Spinal Cord
Pathology in MS
DEMYELINATION
⬇️
AXONAL ATROPHY
⬇️
NEURONAL LOSS
⬇️
CORTICAL ATROPHY
Most important target in MULTIPLE SCLEROSIS
⭐ Myelin BASIC Protein: attacked by T cells
✨ Myelin OLIGODENDROCYTE Glycoprotein MOGP : Attacked by antibody
HLA Association of MS
HLA DR-B1 15:O1
HLA DR2
Types of MS
⚡⚡ MOST COMMON TYPE OF MS
Relapsing-Remitting
EYE INVOLVEMENT IN MS
- OPTIC NEURITIS: U/L, ASYMMETRICAL, PAINFUL, RETROBULBAR PAIN, ANTERIOR VISUAL FIELD AFFECTED
- PENDULAR NYSTAGMUS
- B/L INO ➕ B/L TRIGEMINAL NEURALGIA
- PSEUDO-BULBAR INVOLVEMENT
✨ U/L ASYMMETRICAL, PAINFUL VISUAL LOSS, RETROBULBAR PAIN ➕, ANTERIOR VISUAL FIELD AFFECTED ➕ BETTER RESPONSIVE TO Tx
✨ B/L SYMMETRICAL, PAINLESS VISUAL LOSS, POSTERIOR VISUAL FIELD AFFECTED ➕ LESS RESPONSIVE
⭐ MS
⭐ NMO
Causes of OPTIC NEURITIS
🧑🏻⚕️ Clinical Features of OPTIC NEURITIS
History of PERSISTANCE OF AFTER IMAGE Characteristic feature of
RETROBULBAR NEURITIS
ASSOCIATED with MULTIPLE SCLEROSIS, NMO
Typical vs Atypical Optic Neuritis
Typical ON : DUE TO: DEMYELINATING DISORDERS
Atypical ON: DUE TO: other causes
Which type of OPTIC NEURITIS is NOT ASSOCIATED WITH MULTIPLE SCLEROSIS
Neuro-Retinitis
Paroxysmal Convergence Spasm Phenomenon
Typical but RARE symptom of MS
CAUSED DUE TO: abnormal excitation in DEMYELINATED PLAQUES
McDonald’s Criteria used for
Multiple Sclerosis
McDonald’s Criteria
Dissemination in TIME: 2 Clinical/Radiological Attacks, 1 month apart
Dissemination in SPACE: Involvement of 2 Site, 2 attacks = MS
Lesion Site of MS
- Juxtacortical / Cortical
- Peri ventricular
- Brainstem
- Spinal Cord
- Infra tentorial
- Cerebellar
Gold STANDARD TEST FOR MS
IEF(Isoelectric focussing) and Immunofixation (IgG)
CSF Finding in MS
- IgG ⬆️ > 90 %
- IgG Oligoclonal Bands
Peri ventricular lesion
MS
💊💉 MANAGEMENT of ACUTE ATTACK of MS
High DOSE IV Methyl Prednisolone
(500mg-1mg for 3 continuous days)
No tapering
💊PREVENTION OF ATTACKS OF MS
🧠⚡ ANTI-FOG⚡
Disease modifing therapies ➕ Steroids
✨ Injectable
IFN beta, Glatiramer acetate
✨ Infusibles
Natalizumab, Alemtuzumab
✨ Oral drugs
Fingolimod, Teriflunomide
Natalizumab is Monoclonal Antibody against
Alpha 4 Integrin
USE: MS
ALEMTUZUMAB is Monoclonal Antibody against
anti CD 52
USE: MS
Most preferred DRUG in Remission management in MS
Teriflunomide
Ocrelizumab is Monoclonal Antibody against
CD20
USE: Primary Progressive MS
ONLY DRUG used for PRIMARY PROGRESSIVE MS
Ocrelizumab
Acute ATTACK of MYELITIS (Long Segment Lesion)
➕
OPTIC NEURITIS PAINLESS
➕
Disabling disease with NORMAL MRI
NMO
Autoantibodies seen in NMO
Anti-Aquaporin 4
💊💉 MANAGEMENT of NMO
Steroids ➕ PLASMA EXCHANGE
Poor Prognosis
Anti-MOG antibodies SPECTRUM
(Myelin OLIGODENDROCYTE Glycoprotein)
- ADEM
- ISOLATED OPTIC NEURITIS (INCLUDING CRION)
- Aquaporin 4 antibody negative NMO
- ISOLATED MYELITIS
POST-INFECTIOUS/ POST-IMMUNIZATION
➕
CHILD
➕
ENCEPHALOMYELITIS (Altered Sensorium)
➕
Quadriplegia
ADEM
DIAGNOSTIC FEATURES OF ADEM on MRI
Fluffy White Matter Hyperintensities
💊💉 BEST MANAGEMENT of ADEM
IVIG
SPEED OF CONDUCTION OF NERVE IMPULSE
⭐ With MYELIN
⭐ Without MYELIN
⭐ 70 mm/sec
⭐ 1 mm/sec