Lecture 15 - MS

Question 1

4 clinical subtypes of MS:

which is most common to present with?

Answer 1

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

Question 2

basic immunology behind MS

Answer 2

hyperactive Th1 and Th17 cells; attacking myelin

not being kept in check by Treg and Th2

Question 3

possible causes of MS

suspected chromosome?
what viruses?
what environemntal factors?

Answer 3

genetics – chromosome 6 mutatins

Viral – EBV, JC, HIV

Environemnt – Vit D def, smoking, high salt

Question 4

what features are seen on histopathology?

what’s seen on MRI

Answer 4

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)

Question 5

Common initial presentations for MS

Later onset symptoms

Answer 5

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

Fatigue, Spasticity, sexual dysfunction, cognitive

Question 6

whats needed to make the formal dx of MS

Answer 6

2 episodes of symptoms at different time points

Meet MRI criteria –

absence of other treatable causes

Question 7

Treatment of MS

Answer 7

Drugs – acute – Corticosteroids
Longer term – IVIG?

Nutritional – vit d, low fat, fish oils

Physical therapy

Psychosocial support

symptom management – gabapentin

Question 8

three other demyleinating disease of this lecture?

Answer 8

• Neuromyelitis Optica – Devic’s Disease
  
  • Acute Disseminated Encephalomyelitis
  • Transverse Myelitis

Question 9

• Neuromyelitis Optica – Devic’s Disease

mutation to..?
main lesions to
Treamtnet?

Answer 9

Aquaporin 4 of astrocytes and vasculature

Optic nerve and spinal cord

treatment: acute – streoids
prophlaxis – Rituximab

Question 10

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

Answer 10

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

• virus, vaccine

    * Treatment: 
        * High dose steroids 
  
    MRI	• Cotton ball lesions;