L9: Multiple Sclerosis - Pt 1 Flashcards
Normal anatomy & physiology
- related to MS
Read From Notes
What are Demylinating Diseases?
Examples of Demylinating Diseases
Def of MS
Causes of MS
Pathlogy in MS
Pathlogy in MS
- Characterestic Lesions
Pathlogy in MS
- Sites Affected
Pathlogy in MS
- Sites Spared
- The BBB is disrupted at the …… of symptoms
- Onset is not known yet whether demyelination precedes or is secondary to inflammation
Onset
Composition of BBB
- The BBR is composedof endothelial cells: which line the blood vessel walls of the CNS.
- The cells lining the BBB are connected by occludin and claudin which form tight junctions in order to create a barrier to keep out larger molecules such as proteins.
In Order to pass thru BBB, …..
In order to pass through, molecules must:
- be taken in by transport proteins
- alteration in the BBB permeability.
Pathogenesis of BBB Disruption
Pathogenesis of BBB Disruption
- Activation of Myelin-Reactive T-cells
Pathogenesis of BBB Disruption
- T-Cells Secrete
Pathogenesis of BBB Disruption
- Macrophages
Macrophages engulf oligodendrocytes
Pathogenesis of BBB Disruption
- B-Cells
B-cells produce antibodies against myelin
Pathogenesis of BBB Disruption
- Vicious Cycle
The severity of demyelination may be assessed by ….
relative preservation or destruction of ligodendrogliocytes.
Loss of myelin results in one or all of the following:
Autoimmunity & MS
Summary of pathophysiology of MS
Summary of pathophysiology of MS
- BBB
Summary of pathophysiology of MS
- Auto-immunity
Summary of pathophysiology of MS
- Inflammation
Incidence of MS
- 200 people are diagnosed every week in U.S.
- As of 2008, 2-2.5 million people worldwide are
Age in MS
- 10 and 80 years of age
- Usually begin Between 20 and 40
(mean age of 32)
Race & Sex in MS
- Women than men (2:1)
- Caucasians more than Hispanics or African Americans, less common in Asians.
- Increases the farther one travels from the equator in either hemisphere
CP of MS
(affect any area of the Brain, Optic nerve, or Spinal cord, causing almost any neurologic symptom)
- Sensory
- Motor
- Visual
- cerebellum
- Neuropsychiatric
- Genaturinary
- Fatigue
- Utthoff’s Sign
- Relapse
CP of MS
- Visual
CP of MS
- Internuclear ophthalmoplegia (INO)
CP of MS
- Sensory
CP of MS
- L’hermitte’s Sign
- Electrical sensations run down the spine when the patient bends her head forward due to lesion of the dorsal column of cervical cord or cauda medulla
CP of MS
- MS Hug
Tightening around the chest
CP of MS
- Motor
CP of MS
- Cerebellar
- Tremors
- Ataxia
CP of MS
- Neuropsychiatric
- Depression
- Irritability
- Anxiety
- Memory & Concentration Abnormalities
CP of MS
- Genaturinary
CP of MS
- Intractable Fatigue with no Other Causes
…
CP of MS
- Uthoff’s Phenomenon
Classic MS Sign
- Worsening of symptoms in the heat (hot weather, exercise, fever)
CP of MS
- Relapse
Def of Relapse in MS
- Worsening of present symptoms or appearance of new symptoms
- At least 24 h
- 1 month from East attack
- Not during steroid withdrawal or infection
- Increased EDDS ≥ .5
Symptoms Characters in Relapse in MS
- Develop over a few days
- Improve over weeks or months
- Followed by a period of stability (a remission)
- Stabilize for a few weeks
The Most common initial Symptoms in MS
- Changes in sensation in the arms, legs or face (33%)
- Optic neuritis (20%)
- Weakness (13%)
- Double vision / internuclear
- ophthalmoplegia (7%)
- Unsteadiness when walking (5%)
- Balance problems (3%)
Classification of MS
Classification of MS
- PRMS
Classification of MS
- SPMS
Classification of MS
- PPMS
Classification of MS
- RRMS
Def of EDSS
- Method of quantifying disability in multiple sclerosis & monitoring changes in the level of disability overtime. It is widely used in the assessment of people with MS.
EDSS is Based upon ……
Prognosis in MS
Prognosis in MS
- Good
Prognosis in MS
- Poor
Def of Clinically Isolated Syndome in MS
Individual’s first episode of neurological symptoms lasting at least 24 hours.
Clinically Isolated Syndome in MS
- Optic Neuritis
- Typically unilateral
- Retrobulbar
- Typically painful
- Some recovery expected
- No retinal exudates
- No macular star
- Disc hemorrhages infrequent
Clinically Isolated Syndome in MS
- Myelitis
- Partial sensory or motor
- Sensory more common
- L’hermitte sign
- Bowel and bladder dysfunction
- Band-like abd. or chest pressure
- Acute dystonias
Clinically Isolated Syndome in MS
- Cerebellum
- Cerebellar outflow tremor
- Acute ataxic syndrome
Clinically Isolated Syndome in MS
- Brainstem/Cerebrum
- Ocular motor syndromes (e.g. intranuclear ophthalmoparesis/ nystagmus)
- Hemisensory, crossed sensory syndromes
- Hemiparesis
- Hemifacial spasm
- Trigeminal neuralgia
Clinically Isolated Syndome in MS
- Paroxysmal Symptoms
- Tonic spasms
- Paroxysmal dysarthria/ataxia
Dx of MS
Dx of MS
- Apsects
- Exclude other explanations
- Prove it is M.S diagnoses
Dx of MS
- Clinical
- History and examination (all c/p not single symptom)
- Evidence of CNS involvement.
- Dissemination in space and time
Dx of MS
- INVx (Paraclinical)
- Neuroimaging.
- Evoked potentials.
- CSF analysis.
Dx Criteria of MS
Dx of MS
- MRI
Dx of MS
- Evoked Potentials
Dx of MS
- CSF Examination
CSF Examination in MS
- Sensitivity
Abnormal in 85% to 90% of patients with MS.
CSF Examination in MS
- Cells
Increased, specially during activity up to 40 cells/ mm3
CSF Examination in MS
- Total Protein
moderately Increased
CSF Examination in MS
- Gamma Globulin
Increased, especially IgG ( T total IgG, IgG ratio, IgG synthesis rate).
CSF Examination in MS
- Oligoclonal Bands
- Presence of two or more oligoclonal bands in the CS that are not present in a simultaneously drawn serum sample ICS examination
CSF Examination in MS
- IgG Index
Done
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