How do we define multiple sclerosis?
Immune mediated disease of CNS, associated with:
- Inflammation
- demyelination
- axonal loss/neurodegernation
What is the etiology of MS?
Unknown, but potentially autoimmune or viral
Is there a test for MS?
No, a clinical diagnosis
What are the genetic risk factors for MS?
Female gender
HLA-DR2 allele
What are the environmental risk factors for MS?
EBV infection
Vitamin D insufficency
Smoking
Obesity
What is the pathology of MS
White matter plaques
What is complexity of MS?
Unsure if inflammation or neurodegeneration
What is targeted in MS pathogenesis?
oligodendrocytes
white AND gray matter
How can we track MS symptoms?
According to brain regions that are affected
What are the KEY symptoms of MS?
Optic neuritis
Intranuclear ophthalmoplegia
Myelitis
Trigeminal neuralgia
What are the 3 types of MS, and which is most common?
Relapsing/remitting --> secondary progressive Primary progressive (10%)
What are the principles of RRMS diagnosis? (3)
- At least 1 objective clinical episode w/ neuro symptoms for 24 hours or longer
- Dissemination in time and in space
- Exclusion of common mimic disorders (clinical history, MRI, lab tests)
What laboratory tests are used for look for MS?
MRI
Blood tests: eliminate lyme, B12 deficiency
CSF: for PPMS
Evoked potential: not included now
What findings do we see in a CSF sample? (2) Is this diagnostic?
NO
- Elevated IgG index
- Oligoclonal bands
What are common diseases that mimic MS?
Lyme SLE Sarcoidosis Neuromyelitis optica ADEM B12 deficiency Cervical/thoracic spondylosis
What is neuromyelitis optica?
inflammatory demyelination of optic nerves and spinal cord
What is neuromyelitis optica characterized by?
specific IgG antibody marker: NMO antibody
What is the target antigen of neuromyelitis optica?
aquaporin-4, a water channel abundant in the CNS
What is neuroborreliosis, and how does it mimic MS?
- NB produces focal neurological deficits, relapsing, remitting disease
- MS-like features found in 75% of patients with neuroborreliosis with focal symptoms - often indistinguishable!
How is CNS lupus confused with MS?
- CNS lupus presents with multiple types of white matter lesions on brain MRI, demyelinating lesions in brainstem, optic nerve and spinal cord
- Associated with many neurological symptoms
What similar features do MS and B12 deficiency have?
- Neurological symptoms and lesions
- Linked to occasional multiple focal and confluent white matter hyperintensities on brain MRI
What often causes B12 deficiency?
pernicious anemia - autoimmune disorder attacking IF
What is ADEM?
Acute disseminated encephalomyelitis
How does ADEM mimic MS?
Often monophasic demyelinating disease, very difficult to differentiate from 1st MS attack
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Organization of Nervous System58
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Meninges & Ventricles39
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Meningitis10
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Lower Motor Neurons15
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Upper Motor Neurons8
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Somatosensory Pathways59
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Neuropathy56
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Pain52
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Miscellaneous cards1
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Local Anesthetics48
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Opioid Pharmacology93
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Overcoming CNS Response to Injury14
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Vestibular System53
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Auditory System36
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Multiple Sclerosis38
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General Anesthesia50
