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Flashcards in Lecture 15 - MS Deck (10):

4 clinical subtypes of MS:
which is most common to present with?

1) Relapsing-Remitting -- 80% at Diagnosis

2) Primary Progressive -- 10-15% at Dx

3) Secondary Progressive - 50% of RR after 15 years
Gradual accumulation of disability
No more relapsing and remitting

4) Progressive relapsing -- Rare


basic immunology behind MS

hyperactive Th1 and Th17 cells; attacking myelin
not being kept in check by Treg and Th2


possible causes of MS

suspected chromosome?
what viruses?
what environemntal factors?

genetics -- chromosome 6 mutatins

Viral -- EBV, JC, HIV

Environemnt -- Vit D def, smoking, high salt


what features are seen on histopathology?

what's seen on MRI

extravasion of immune cells out of venule
Demyelination of axonal pathway

T2 MRI -- Dawson's fingers; lesions perpendicular to long axis of ventricles (gray matter)


Common initial presentations for MS

Later onset symptoms

Optic Nerve Inflammation
Poor Balance (Ataxia)
Dizziness (vertigo)
Double Vision Bowel bladder
Sensory Loss

Fatigue, Spasticity, sexual dysfunction, cognitive


whats needed to make the formal dx of MS

2 episodes of symptoms at different time points

Meet MRI criteria --

absence of other treatable causes


Treatment of MS

Drugs -- acute -- Corticosteroids
Longer term -- IVIG?

Nutritional -- vit d, low fat, fish oils

Physical therapy

Psychosocial support

symptom management -- gabapentin


three other demyleinating disease of this lecture?

• Neuromyelitis Optica -- Devic's Disease
• Acute Disseminated Encephalomyelitis

• Transverse Myelitis


• Neuromyelitis Optica -- Devic's Disease

mutation to..?
main lesions to

Aquaporin 4 of astrocytes and vasculature

Optic nerve and spinal cord

treatment: acute -- streoids
prophlaxis -- Rituximab


• Acute Disseminated Encephalomyelitis
reaction to...?
inflammation of?
What's seen on MRI?

inflammation of the brain, spinal cord and, occasionally, optic nerves

- virus, vaccine

• Treatment:
• High dose steroids

MRI • Cotton ball lesions;