multiple sclerosis W5 Flashcards
what’s MS?!!?!?!?
chronic inflammatory and degenerative disease of the central nervous system
how is MS characterised pathologically
inflammation
demyelination +/- variable extent of remyelination
neuroaxonal injury/loss
astrogliosis
astrogliosis?
scarring due to proliferation of astrocytes and damaged areas of the nervous system (areas of sclerosis)
MS epidemiology?
more cases north - due to sunshine exposure (reduced sun exposure = reduced vit D)
more common in women than men
peak incidence age 40
risk factors for MS?
genetics
environment (vitamin D, smoking, EBV, obesity)
EBV?
Epstein-Barr virus (type of herpes)
triggers for MS?
pathogens
relapsing remitting MS?
attacks (relapses) occur then neurological function returns to baseline (remission)
secondary progressive MS?
attacks occur and patient does not return to baseline - dont fully recover. patient accumulates fixed disabilities. develops to progressive phase where attacks don’t occur, symptoms just get increasingly worse
primary progressive MS?
from outset patients don’t have attacks, just get progressively worse
MS diagnosis?
diagnosis of exclusion
history/examination (dissemination in space and time)
tests - MRI, lumbar puncture
criteria is McDonald Criteria
dissemination of space and time?
disease affects different parts of the nervous system at different times.
features of MS MRI?
patches of increased T2 signal hyperintensity within white matter (particularly around ventricles). These are areas of gliosis/scarring.
how do we see dissemination in time on MRI?
give contrast - gadolinium.
an acute lesion will show leakiness of BBB. gadolinium in blood will leak into brain, lesions will light up. longstanding lesions won’t light up.
purpose of lumbar puncture test for MS?
oligoclonal bands - non specific antibodies that we pick up in the CSF. compare CSF to serum, if there are bands in CSF that aren’t in serum you know they haven’t leaked in from blood, therefore immune system is active in CSF.
95% sensitive
