Lecture 15 - MS Flashcards
4 clinical subtypes of MS:
which is most common to present with?
1) Relapsing-Remitting – 80% at Diagnosis
2) Primary Progressive – 10-15% at Dx
3) Secondary Progressive - 50% of RR after 15 years Gradual accumulation of disability No more relapsing and remitting 4) Progressive relapsing -- Rare
basic immunology behind MS
hyperactive Th1 and Th17 cells; attacking myelin
not being kept in check by Treg and Th2
possible causes of MS
suspected chromosome?
what viruses?
what environemntal factors?
genetics – chromosome 6 mutatins
Viral – EBV, JC, HIV
Environemnt – Vit D def, smoking, high salt
what features are seen on histopathology?
what’s seen on MRI
extravasion of immune cells out of venule
Demyelination of axonal pathway
T2 MRI – Dawson’s fingers; lesions perpendicular to long axis of ventricles (gray matter)
Common initial presentations for MS
Later onset symptoms
Optic Nerve Inflammation Poor Balance (Ataxia) Dizziness (vertigo) Weakness Double VisionBowel bladder Pain Sensory Loss
Fatigue, Spasticity, sexual dysfunction, cognitive
whats needed to make the formal dx of MS
2 episodes of symptoms at different time points
Meet MRI criteria –
absence of other treatable causes
Treatment of MS
Drugs – acute – Corticosteroids
Longer term – IVIG?
Nutritional – vit d, low fat, fish oils
Physical therapy
Psychosocial support
symptom management – gabapentin
three other demyleinating disease of this lecture?
- Neuromyelitis Optica – Devic’s Disease
- Acute Disseminated Encephalomyelitis
• Neuromyelitis Optica – Devic’s Disease
mutation to..?
main lesions to
Treamtnet?
Aquaporin 4 of astrocytes and vasculature
Optic nerve and spinal cord
treatment: acute – streoids
prophlaxis – Rituximab
• Acute Disseminated Encephalomyelitis reaction to...? inflammation of? treatment? What's seen on MRI?
inflammation of the brain, spinal cord and, occasionally, optic nerves
- virus, vaccine
* Treatment: * High dose steroids MRI • Cotton ball lesions;