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Applied Neuroanatomy > De-myelinating diseases and MS > Flashcards

De-myelinating diseases and MS Flashcards

1
Q

What does demyelination refer to?

A

the preferential destruction of the myelin sheath of the axon

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2
Q

What may cause the loss of myelin?

A

the breakdown of normal myelin or abnormal production of myelin

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3
Q

Where is myelin derived in the CNS?

A

oligodendrocytes

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4
Q

What is the purpose of myelin?

A

insulation to allow fast conductance along cell membrane

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5
Q

What is primary demyelination?

A

where the primary pathology is demyelination - MS

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6
Q

What is secondary demyelination?

A

demyelination due to another disease i.e. AIDS, axonal degeneration, sub-acute sclerosing panencephalitis (from measles)

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7
Q

What toxins may produce demyelination?

A

cyanide, CO low grade poisoning, solvents

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8
Q

Where is MS most common?

A

north and west

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9
Q

What is the ratio of MS in males and females?

A

female 2:1

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10
Q

What is the age of onset of MS?

A

any although childhood and 50+ is rare

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11
Q

What is the definition of MS?

A

episodes of neurological deficit separated by time

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12
Q

Why is MS so difficult to diagnose?

A

never on first time
second episode is usually different to first
lesions in brain are desiminated in time and space
several more common explanations exist for initial symptoms

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13
Q

What are the genetic linkages in MS?

A

MHC linkages

monozygotic concordance rates

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14
Q

Why is it suggested that MS could be caused by a virus?

A

patients with MS are more likely to have measles Ab in CSF

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15
Q

What are the clinical features?

A

acute or insidious, variable distribution
relapsing and remitting flare ups
common manefestations include: visual disturbances, parasthesia, spasticity of extremities, speech disturbance

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16
Q

What appears in MRI scans of MS?

A

looking for unmatched light areas (un-myelinated areas)

17
Q

What is a common site for demyelination in MS?

A

around ventricles and corpus callosum - sometimes occipital lobe

18
Q

What can be seen in lesions when cutting the surface of MS brain?

A

acute lesions are soft and pink

older chronic lesions are firm and pearly grey

19
Q

Where are lesions commonly seen?

A

cranial nerve II - occipital nerve, corpus callosum, brain stem and spinal cord

20
Q

What may MS lesions act as?

A

space occupying lesions

21
Q

What are the types of MS plaques?

A

acute active plaques
chronic inactive plaques
chronic active plaques
shadow plaques

22
Q

What are acute active plaques?

A

ongoing myelin breakdown

23
Q

What are chronic inactive plaques?

A

little/no myelin, astrocytic/gliosis prominent

24
Q

What are shadow plaques?

A

border between normal and affected matter not clearly defined

25
Q

What is the feature of acute MS?

A

plaques are yellow/brown with an ill defined edge that blends into surrounding why matter

26
Q

What is the feature of chronic MS?

A

plaques are grey brown lesions in white matter, classically situated around lateral ventricles

27
Q

What are the histological features of MS?

A
  • demyelination with chronic plaques
  • inflammation - perivascular inflammation and oedema, -predominantly with lymphocytes
  • gliosis - prominent feature of plaques
28
Q

What are the potential reasons for MS?

A

sunlight
higher sausage consumption
vikings?

29
Q

How is Vitamin D metabolised by the liver?

A

hydroxylated on C25 and then C1 in kidney

30
Q

What is Vitamin D important in?

A

calcium balance in the immune response

31
Q

How has MHC been brought into MS?

A

class II mapped to the same haplotype in norther-european populations

32
Q

What was found in a canadian MS cohort?

A

confirmed linkage to HLA DRB1-15 although probably not that gene - closely related

33
Q

What was the proposed gene close to DRB1-15?

A

Vitamin D Response Element

34
Q

Why is it unlikely to be the HLA DRB1-15?

A

neg. patients still have MS, only 1 in 100 MS patients homozygous for it

35
Q

What is HLA DRB1-15/0101?

A

a promotor polymorphism which confers vitamin D sensitivity in HLA DRB1 expression

36
Q

Where else is high expression HLA DRB1-15/01 found?

A

other immune related diseases such as asthma, T1DM and ulcerative colitis

37
Q

What happened in 2011 with regards Vit D and MS?

A

Oxford researchers found a link between MS and the enzyme CYP27B1 - an enzyme important in regulating vitamin D levels in the body

38
Q

What did researchers at the McGill university in canada find?

A

a link between 4 SNP and the 25OHD levels. Higher levels of 25OHD are associated with a decreased level of MS. The alterations in these polymorphisms were across tens of thousands of northern populations all of european decent

Applied Neuroanatomy (11 decks)

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