Wednesday, July 23, 2008

122 - multiple sclerosis part 1

  1. sparing of the peripheral nervous system ( PNS ) is typical of Multiple sclerosis ( MS ) .

  1. MS is not associated with any systemic illness.

  1. CNS myelin is typically involved.

  1. the disease has a typical waxing and waning course .

  1. perivenular cuffing is present

  1. T cells and macrophage inflammation is present

  1. disruption of blood brain barrier

  1. there is no disruption of vessel wall

  1. MS is thrice as common in women as in men

  1. age of onset is typically between 20 and 40 years

  1. the disease can begin as early as 2 years and as late as 8th decade .

  1. prevalence of MS increases with increasing distance from equator

  1. MS is polygenic

  1. the most important MS susceptibility region is MHC on chromosome 6p21

  1. DR2 is associated with MS

  1. anti MOG ( myelin oligodendrocyte glycoprotein ) antibodies are predictive of future MS .

  1. oligoclonal antibody is seen in MS

  1. TH1 cytokines TNF, IL2 and IFN gamma are central to MS pathogenesis .

  1. MS is common in high socioeconomic status , the cause being delayed exposure to infectious organisms .

  1. Theiler virus model is the best studied experimental model of MS

  1. HHV 6 and Chlamydia pneumoniae can be associated with MS

  1. sensory loss is the most common initial symptom of MS

  1. exercise induced weakness is characteristic symptom of MS

  1. Visual symptoms in MS are mostly monocular .

  1. periorbital pain aggravated by movement precedes visual loss

  1. UVEITIS IS RARE

  1. lesion in ipsilateral MLF leading to impaired adduction of one eye ( internuclear opthalmoplegia ) is common .

  1. bilateral internuclear opthalmoplegia is particularly suggestive of MS

  1. horizontal gaze palsy + internuclear opthalmoplegia is called ONE AND HALF SYNDROME .

  1. acquired pendular nystagmus is a common gaze disturbance in MS

  1. UHTHOFF’S SYMPTOMS : neurological symptoms in MS getting aggravated by elevation of body’s core temperature is called uhthoff’s phenomenon .

  1. the most common disease course in MS is relapsing remitting multiple sclerosis ( RRMS )

  1. leakage of gadolinium dye on MRI is an early marker of MS

  1. lesions in MS on MRI are frequently oriented perpendicular to ventricular surface

  1. lesions of anterior corpus callosum on MRI are common in MS

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