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Multiple Sclerosis - Coggle Diagram
Multiple Sclerosis
Diagnosis
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MRI
Demonstrates multifocal white matter abnormalities (Asymmetrical, irregular ovoid or round, periventricular, corpus callosum, cerebellar, brainstem)
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CSF
Normal RBC, Glucose, Mildly elevated Protein
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Schumacher Criteria
Age 10-50, 2 lesions disseminated in space and time (Separated by 1 month, and lasting >24 hrs), progression over 6 months, abnormal neurological exam, white matter localization
Mcdonald Criteria
Quite complex, still a clinical diagnosis, includes MRI, Emphasis on MRI (Mri changes over time), Oligoclonal banding in questionable cases
Pathophysiology
Pathology
White blood cell infiltration aroudn small veins, demyelination around small veins
Plaques of Demyelination: Microscopic perivenular demyelinated areas coalesce as macroscopic plaques
Function of Myelin
Increases speeds of conduction, and saves space
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Molecular Mimicty
Systemic viral infection -> Activation of T cells against viral antigens -> Expansion of T cells -> T cells attack and cure infection -> T cells move into CNS compartment -> Attack on myelin
Transformed B cells
EBV INfection - infects B cells -> Latency in B cells -> B cells are transformed by the virus -> B cell happened to be autoreactive -> Autoimmune disease
Epidemiology
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Racial effects
High in caucasians, and low in African, asian and NA indigenous and inuit populaitons
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Migration Studies
Migrants from countries in high risk zone to those in low risk zone - > Adults retain risk and children closer to risks in new country
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Treatment
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Symptoms
Spasticity: Baclofen, tizanidine
Pain: Gabapentin, pregabalin, AMitriptyline carbamazepine, duloxetine
Fatigue: Amantadine, modafinil
Tremor: Weights, braces, clonazepam
Bladder dysfunction: Ditropan, detrol, solifenacin, Mirabegron
Disease Modifying
Goals
Reduce frequency, reduce plaque formation, delay disability
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Presentations
Clinical Effects
Limb weakness, limb paresthesia, limb numbness, optic neuritis, diplopia, bladder dysfunction, vertigo
Presentation
Cerebral localization, optic neuritis, transverse myelitis, brainstem or cerebellar syndrome
Uhtoff's Phenomenon
With heat, conduction slows along axons, and in demyelinated plaques
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Results in resurgence of MS symptoms (visual blurring, numbness and tingling)
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MS Attacks
Comes on over hours/days last days-weeks, and improves (Weakness, numbess, tingling, vision loss, double vision, imabalnce, dizziness)
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