multiple sclerosis Flashcards
Multiple sclerosis
an autoimmune disorder
a demyelinating disease, breaking down the myelin
more prevalent in women
chronic inflammatory disease of te central nervous system which leads to large focal lesions characterized by demyelination
risk factors
- vitamin D deficiency
- obesity early in life
- cigarette smoking
- associated to specific infections
- genetics; through sequencing the genome
diagnostic hallmark
presence of large confluent demyelinated lesions in white and grey matter
dysmyelinating disease / leukodystrophy
myelin is not properly formed or has abnormal turnover kinetics.
Most mutations involved in formation of myelin.
demyelinating disease
damage to the normal myelin
MS is the most common
myelin plasticity
determines the size/strong of the signal
- de novo myelination of unmyelinated axon segment
- retraction or replacement of existing segments
- thickening or thinning of existing myelin sheets
- lengthening or shortening of existing myelin sheets
pathogenesis
- acute phase; inflammation
- loss of myeline and oligodendrocytes
- reactive proliferation and hypertrophy of glial cells
- development of multifocal lesions (plaques)
- loss of neurons
plaques
inactive plaques; inflammation has disappeared
active plaques; abundant macrophages and t-cells, active inflammatory process
symptoms
fatigue, muscle spams, tingling, disturbed balance, difficulty walking, numbness.
the symptoms depend on the place of the lesions.
early stage
immune cell infiltration, breach of the BBB
increased inflammatory response, myeline will be damaged.
late stage
lower infiltration of peripheral immune cells
chronic intrinsic inflammation and suppress damage repair
diagnosis
- McDonald criteria
- medical history
- neurological exam; functional
- evoked potential tests; brain response
- lumbar puncture; to see what the spinal fluid contains
- MRI; more white is accumulation of lipid
- differential diagnoses
McDonald criteria
evidence of damage to the central nervous system that is disseminated in time and space.showing that damage has occurred at different dates and to different parts of the central nervous system
second stage
progressive-relapsing MS
symptoms gradually become worse, but distinction between attacks and remission
can progress into secondary progressive MS
first stage
clinically isolated syndrome
relapsing-remitting MS
pain comes in attacks