L9: Multiple Sclerosis - Pt 1

Question 1

Normal anatomy & physiology

• related to MS

Answer 1

Read From Notes

Question 2

What are Demylinating Diseases?

Answer 2

Question 3

Examples of Demylinating Diseases

Answer 3

Question 4

Def of MS

Answer 4

Question 5

Causes of MS

Answer 5

Question 6

Pathlogy in MS

Answer 6

Question 7

Pathlogy in MS

• Characterestic Lesions

Answer 7

Question 8

Pathlogy in MS

• Sites Affected

Answer 8

Question 9

Pathlogy in MS

• Sites Spared

Question 10

• The BBB is disrupted at the …… of symptoms
• Onset is not known yet whether demyelination precedes or is secondary to inflammation

Answer 10

Onset

Question 11

Composition of BBB

Answer 11

• The BBR is composedof endothelial cells: which line the blood vessel walls of the CNS.
• The cells lining the BBB are connected by occludin and claudin which form tight junctions in order to create a barrier to keep out larger molecules such as proteins.

Question 12

In Order to pass thru BBB, …..

Answer 12

In order to pass through, molecules must:

• be taken in by transport proteins
• alteration in the BBB permeability.

Question 13

Pathogenesis of BBB Disruption

Answer 13

Question 14

Pathogenesis of BBB Disruption

• Activation of Myelin-Reactive T-cells

Answer 14

Question 15

Pathogenesis of BBB Disruption

• T-Cells Secrete

Answer 15

Question 16

Pathogenesis of BBB Disruption

• Macrophages

Answer 16

Macrophages engulf oligodendrocytes

Question 17

Pathogenesis of BBB Disruption

• B-Cells

Answer 17

B-cells produce antibodies against myelin

Question 18

Pathogenesis of BBB Disruption

• Vicious Cycle

Answer 18

Question 19

The severity of demyelination may be assessed by ….

Answer 19

relative preservation or destruction of ligodendrogliocytes.

Question 20

Loss of myelin results in one or all of the following:

Answer 20

Question 21

Autoimmunity & MS

Answer 21

Question 22

Summary of pathophysiology of MS

Question 23

Summary of pathophysiology of MS

• BBB

Answer 23

Question 24

Summary of pathophysiology of MS

• Auto-immunity

Answer 24

Question 25

Summary of pathophysiology of MS - Inflammation

Answer 25

Question 26

Incidence of **MS**

Answer 26

- 200 people are diagnosed every week in U.S. - As of 2008, 2-2.5 million people worldwide are

Question 27

Age in **MS**

Answer 27

- 10 and 80 years of age - Usually begin Between 20 and 40 (mean age of 32)

Question 28

Race & Sex in **MS**

Answer 28

- Women than men (2:1) - Caucasians more than Hispanics or African Americans, less common in Asians. - Increases the farther one travels from the equator in either hemisphere

Question 29

CP of **MS**

Answer 29

**(affect any area of the Brain, Optic nerve, or Spinal cord, causing almost any neurologic symptom)** - Sensory - Motor - Visual - cerebellum - Neuropsychiatric - Genaturinary - Fatigue - Utthoff's Sign - Relapse

Question 30

CP of **MS** - Visual

Answer 30

Question 31

CP of **MS** - Internuclear ophthalmoplegia (INO)

Answer 31

Question 32

CP of **MS** - Sensory

Answer 32

Question 33

CP of **MS** - L'hermitte's Sign

Answer 33

- Electrical sensations run down the spine when the patient bends her head forward due to lesion of the dorsal column of cervical cord or cauda medulla

Question 34

CP of **MS** - MS Hug

Answer 34

Tightening around the chest

Question 35

CP of **MS** - Motor

Answer 35

Question 36

CP of **MS** - Cerebellar

Answer 36

- Tremors - Ataxia

Question 37

CP of **MS** - Neuropsychiatric

Answer 37

- Depression - Irritability - Anxiety - Memory & Concentration Abnormalities

Question 38

CP of **MS** - Genaturinary

Answer 38

Question 39

CP of **MS** - Intractable Fatigue with no Other Causes

Answer 39

...

Question 40

CP of **MS** - Uthoff's Phenomenon

Answer 40

**Classic MS Sign** - Worsening of symptoms in the heat (hot weather, exercise, fever)

Question 41

CP of **MS** - Relapse

Question 42

Def of **Relapse** in **MS**

Answer 42

* Worsening of present symptoms or appearance of new symptoms * At least 24 h * 1 month from East attack * Not during steroid withdrawal or infection * Increased EDDS ≥ .5

Question 43

Symptoms Characters in **Relapse** in **MS**

Answer 43

- Develop over a **few days** - Improve over **weeks or months** - Followed by a period of stability (a remission) - Stabilize for a **few weeks**

Question 44

The Most common initial Symptoms in **MS**

Answer 44

- Changes in sensation in the arms, legs or face (33%) - Optic neuritis (20%) - Weakness (13%) - Double vision / internuclear - ophthalmoplegia (7%) - Unsteadiness when walking (5%) - Balance problems (3%)

Question 45

Classification of **MS**

Answer 45

Question 46

Classification of **MS** - PRMS

Answer 46

Question 47

Classification of **MS** - SPMS

Answer 47

Question 48

Classification of **MS** - PPMS

Answer 48

Question 49

Classification of **MS** - RRMS

Answer 49

Question 50

Def of **EDSS**

Answer 50

- Method of quantifying disability in multiple sclerosis & monitoring changes in the level of disability overtime. It is widely used in the assessment of people with MS.

Question 51

**EDSS** is Based upon ......

Answer 51

Question 52

Prognosis in **MS**

Answer 52

Question 53

Prognosis in **MS** - Good

Answer 53

Question 54

Prognosis in **MS** - Poor

Answer 54

Question 55

Def of **Clinically Isolated Syndome** in **MS**

Answer 55

Individual's first episode of neurological symptoms lasting at least 24 hours.

Question 56

**Clinically Isolated Syndome** in **MS** - Optic Neuritis

Answer 56

1. Typically unilateral 2. Retrobulbar 3. Typically painful 4. Some recovery expected 5. No retinal exudates 6. No macular star 7. Disc hemorrhages infrequent

Question 57

**Clinically Isolated Syndome** in **MS** - Myelitis

Answer 57

1. Partial sensory or motor 2. Sensory more common 3. L'hermitte sign 4. Bowel and bladder dysfunction 5. Band-like abd. or chest pressure 6. Acute dystonias

Question 58

**Clinically Isolated Syndome** in **MS** - Cerebellum

Answer 58

1. Cerebellar outflow tremor 2. Acute ataxic syndrome

Question 59

**Clinically Isolated Syndome** in **MS** - Brainstem/Cerebrum

Answer 59

1. Ocular motor syndromes (e.g. intranuclear ophthalmoparesis/ nystagmus) 2. Hemisensory, crossed sensory syndromes 3. Hemiparesis 4. Hemifacial spasm 5. Trigeminal neuralgia

Question 60

**Clinically Isolated Syndome** in **MS** - Paroxysmal Symptoms

Answer 60

1. Tonic spasms 2. Paroxysmal dysarthria/ataxia

Question 61

Dx of **MS**

Question 62

Dx of **MS** - Apsects

Answer 62

- Exclude other explanations - Prove it is M.S diagnoses

Question 63

Dx of **MS** - Clinical

Answer 63

- History and examination (all c/p not single symptom) - Evidence of CNS involvement. - Dissemination in space and time

Question 64

Dx of **MS** - INVx (Paraclinical)

Answer 64

- Neuroimaging. - Evoked potentials. - CSF analysis.

Question 65

Dx Criteria of **MS**

Answer 65

Question 66

Dx of **MS** - MRI

Answer 66

Question 67

Dx of **MS** - Evoked Potentials

Answer 67

Question 68

Dx of **MS** - CSF Examination

Answer 68

Question 69

CSF Examination in **MS** - Sensitivity

Answer 69

Abnormal in 85% to 90% of patients with MS.

Question 70

CSF Examination in **MS** - Cells

Answer 70

Increased, specially during activity up to 40 cells/ mm3

Question 71

CSF Examination in **MS** - Total Protein

Answer 71

moderately Increased

Question 72

CSF Examination in **MS** - Gamma Globulin

Answer 72

Increased, especially IgG ( T total IgG, IgG ratio, IgG synthesis rate).

Question 73

CSF Examination in **MS** - Oligoclonal Bands

Answer 73

- Presence of two or more oligoclonal bands in the CS that are not present in a simultaneously drawn serum sample ICS examination

Question 74

CSF Examination in **MS** - IgG Index

Answer 74

Question 75

Done

Answer 75

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