122 - multiple sclerosis part 1
- sparing of the peripheral nervous system ( PNS ) is typical of Multiple sclerosis ( MS ) .
- MS is not associated with any systemic illness.
- CNS myelin is typically involved.
- the disease has a typical waxing and waning course .
- perivenular cuffing is present
- T cells and macrophage inflammation is present
- disruption of blood brain barrier
- there is no disruption of vessel wall
- MS is thrice as common in women as in men
- age of onset is typically between 20 and 40 years
- the disease can begin as early as 2 years and as late as 8th decade .
- prevalence of MS increases with increasing distance from equator
- MS is polygenic
- the most important MS susceptibility region is MHC on chromosome 6p21
- DR2 is associated with MS
- anti MOG ( myelin oligodendrocyte glycoprotein ) antibodies are predictive of future MS .
- oligoclonal antibody is seen in MS
- TH1 cytokines TNF, IL2 and IFN gamma are central to MS pathogenesis .
- MS is common in high socioeconomic status , the cause being delayed exposure to infectious organisms .
- Theiler virus model is the best studied experimental model of MS
- HHV 6 and Chlamydia pneumoniae can be associated with MS
- sensory loss is the most common initial symptom of MS
- exercise induced weakness is characteristic symptom of MS
- Visual symptoms in MS are mostly monocular .
- periorbital pain aggravated by movement precedes visual loss
- UVEITIS IS RARE
- lesion in ipsilateral MLF leading to impaired adduction of one eye ( internuclear opthalmoplegia ) is common .
- bilateral internuclear opthalmoplegia is particularly suggestive of MS
- horizontal gaze palsy + internuclear opthalmoplegia is called ONE AND HALF SYNDROME .
- acquired pendular nystagmus is a common gaze disturbance in MS
- UHTHOFF’S SYMPTOMS : neurological symptoms in MS getting aggravated by elevation of body’s core temperature is called uhthoff’s phenomenon .
- the most common disease course in MS is relapsing remitting multiple sclerosis ( RRMS )
- leakage of gadolinium dye on MRI is an early marker of MS
- lesions in MS on MRI are frequently oriented perpendicular to ventricular surface
- lesions of anterior corpus callosum on MRI are common in MS
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