Multple Sclerosis

Question 1

1. Q: What is the initial pathological event in Multiple Sclerosis (MS)?

Answer 1

A: Immune System Activation

Autoimmune response against CNS myelin
Involves activation of T-cells, B-cells, and macrophages

Question 2

2. Q: What happens during the inflammation stage of MS?

Answer 2

A: Immune cells cross the blood-brain barrier (BBB)

T-cells release pro-inflammatory cytokines (e.g. IL-1, TNF-α)
Leads to local inflammation, BBB breakdown, and further immune infiltration

Question 3

3. Q: What is demyelination in MS?

Answer 3

A: Destruction of the myelin sheath around CNS axons

Oligodendrocytes are damaged or destroyed
Conduction of electrical impulses is slowed or blocked
Results in neurological deficits

Question 4

4. Q: What happens to axons in later stages of MS?

Answer 4

A: Axonal damage and neurodegeneration

Chronic inflammation leads to axon transection
Causes irreversible neurological disability

Question 5

5. Q: What is gliosis in MS pathology?

Answer 5

A: Scarring by astrocytes

Damaged areas replaced by astrocytic plaques
Leads to permanent sclerosis (hardened lesions in white matter)

Question 6

6. Q: What is remyelination and how effective is it in MS?

Answer 6

A: Attempted repair by oligodendrocyte precursor cells

May occur in early stages → partial symptom recovery
Less effective over time due to ongoing inflammation and axonal loss

Question 7

7. Q: How does MS progress over time pathologically?

Answer 7

A: From relapsing inflammation to chronic neurodegeneration

Early: Active lesions with inflammation and demyelination
Later: Chronic plaques, widespread axonal loss, brain atrophy

Question 8

Presentation -

Answer 8

🌪️ Relapsing-remitting neurological symptoms (most common pattern)
🧍 Fatigue (very common and often debilitating)
💀 Sensory disturbances:
Numbness or tingling (paresthesia)
Pins and needles
Lhermitte’s sign (electric shock sensation down the spine on neck flexion

👁️ Visual Symptoms
• 👁️‍🗨️ Optic neuritis (unilateral vision loss, pain on eye movement)
• 🌫️ Blurred or double vision (diplopia)
• 👁️ Uhthoff’s phenomenon (worsening of symptoms with heat)

🦵 Motor & Coordination Issues
• 🦶 Weakness (commonly in one limb or one side)
• 🦠 Spasticity (stiff, tight muscles)
• 🌀 Ataxia (poor balance and coordination)
• 🚶 Gait disturbances or foot drop

🧠 Brainstem and Cerebellar Signs
🎯 Vertigo and nausea
🎯 Nystagmus
🎯 Dysarthria (slurred speech)

🧻 Autonomic & Other Symptoms
💧 Bladder dysfunction (urgency, retention, incontinence)
🚽 Bowel dysfunction
🍆 Sexual dysfunction
🧠 Cognitive changes (memory, attention, processing speed)
🧠 Mood disorders (depression, anxiety)