MS Flashcards
Etiology & patho of MS
- a chornic inflammatory autoimmune disease that affects the CNS
- lesions are: autoimmune inflammation and demyleination resulting in axonal loss of mylein
- MC: relapsing/remitting type: wehre symptoms tend to come and go
- affects women > men
main etiology: revolves around understanding there is a chronic inflammatory proccess which results in autoimmune demyleination of teh axons in the CNS
- genetic susceptibility: MHC molecule inflammation: some people more susceptible – HLA_DR2
- some environmental tirggers (lack of VIT D and sunlight is a big one!)
Patho
- T-cells triggerer:cross BBB and cause destruction in the CNS: attack the mylein : white matter attacked (brain and SC)
- when the mylein is lost: you have decrease in the function of the neruons and ability to fire
- get results which are motor, sensory and visaul impairments
Symptoms of MS
SIgns
- primary presentation optic neuritis and sensory dysfunction (increased or decreased) +/- motor dysfunctions
Commonly
- sensory (pain, parasthesias)
- then weakness & visual disturbances (optic neuritits & diplopia)
- trigeminal neuralgia
Others
- cognitive impairment: memory, attention
- baldder, bowel and sexual dysfunction (think SC)
- fatigue (very common)
- depression
Signs
- CN dysfunction; optice neuritis, INO (lesions eyes dont do the same thing), diplopia, trigem nerualiga
- umn lesions: hyperreflexia
- cerebellar dysfunction: gait ataxia, slurred speech
MS Diagnosis
Diagnosis
- made from objective evidence of dissemination in time and spcace of the typical MS lesions
- evidence of clincial symptoms
- MRI with contrast : to see MULTIPLE (at least 2) lesions: white plaques in teh brain on MRI
- LP: to see inflammation in the CSF: CSF antibody levels and see IGg and Oligoclonal bonading
- can do evoked potentails to see brain response
MS Treatment
overtime, those with MS have progressive worsening of the diease and leads to brain atrophy of the white matter
Late Findings
- chronic demyleination & perimnent axonal loss and atrophy
for treatemnt:the progresison of the disease is variable and consistns of relapse, revoery and progression
SOme pts: relapse/remitting type
some pts: progression (just alwasy worsening)
thus: earlier treatment = better outcomes
Acute Exacerbations: high dose steroids IV glucocorticoids
Long Term treatmetn:
first line: interferons (beta?)
rituxamab can be used as it is most effective to reduce lesions on MRi