multiple sclerosis

Chronic Auto immune disease of the CNS
1. Inflammation
2. demyelination
3. axonal degeneration
symptoms of MS
1. common
  1. vision problems-fatigue-parasthesis
    Anmerkungen:
    - paresthesia-pins and needles
  2. bladder/bowel/sexual dysfunction
  3. Gait problem-spasticity
    Anmerkungen:
    - gait-walking problem
  4. pain-depression-cognitive dysfunction
2. less common
  1. headache-hearing loss
  2. itching-seizures-speech/swall. difficulties
slow progression characterized:
1. disseminated patches of demyelination in brain and SC
2. neurological symptoms and signs
3. classical remissions and exacerbations
chronic inflammation (scarring)
1. MS lesions disseminated in time and space
likely triggered by environmental expo in genetically susceptible host
1. environmental factors
  1. viruses:epstein barr virus
  2. insufficient expo to mild infections early life
  3. low sun expo/low Vita D levels
    1. pathway UV radiation induced immunnosupression
      1. UVR-Vita D synthesis-Th1 have Vita D receptors
        activation of these receptors reduces immune activity INVITRO
      2. UVR-immunosupress-subepidermal
        cytokine signaling & other mech. does not involve VitaD
  4. smoking
MS genetics
1. Risk .02% of pop.
Potential triggers
1. infectious agent
2. genetic predisposition
3. environmental factors
An MS "Attack"
1. change in neurological function more than 24 hrs
2. episode last avg. 3-6 wks
  1. length of episode decreased w/ steroid treatment
3. Not MS attack
  1. change neurolog. due to infection/fever
    Anmerkungen:
    - most common infections are UTIs/URIs -experience uhthoff's phenomenon-which is recurrence/worsening of prior MS symptoms secondary to elevation in for body temp. Mechanism: chronic demyelination W transient slowing of conduction
How is MS diagnosed?
1. Dissemination in Space & Time
  Anmerkungen:
  - diagnostic criteria for MS (spread over)
  1. T2 lesions in at least 2 of 4 areas of CNS
    1. periventricular
      1. "classic"periventricular shape
      2. ovoid or dawsons finger
      3. rep-inflammation around medullary veins (outward ventricles
    2. juxacortical( subcortical)
      1. U shaped white matter deep to cortex
    3. brainstem/cerebellum
      1. Infratentorial (aka)
    4. spinal cord
      1. one segment or less of SC
      2. usually dorsal or lateral location
2. DIT Demonstrated by
  1. T2 lesion & follow up MRI

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multiple sclerosis

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