Lecture 15 - MS Flashcards Preview

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Flashcards in Lecture 15 - MS Deck (10):
1

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

2

basic immunology behind MS

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

3

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

4

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)

5

Common initial presentations for MS


Later onset symptoms

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

Fatigue, Spasticity, sexual dysfunction, cognitive

6

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

7

Treatment of MS

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

Nutritional -- vit d, low fat, fish oils

Physical therapy

Psychosocial support

symptom management -- gabapentin

8

three other demyleinating disease of this lecture?

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

• Transverse Myelitis

9

• Neuromyelitis Optica -- Devic's Disease

mutation to..?
main lesions to
Treamtnet?

Aquaporin 4 of astrocytes and vasculature

Optic nerve and spinal cord

treatment: acute -- streoids
prophlaxis -- Rituximab

10

• Acute Disseminated Encephalomyelitis
reaction to...?
inflammation of?
treatment?
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;