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34 Cards in this Set

  • Front
  • Back
What is Multiple Sclerosis (MS)?
Chronic primary demylinating disease of the CNS; also causes axonal injury
Is there one isolated trigger that causes MS?
No
What "causes" MS?
Multifactorial - Genetic predisposition, autimmunity, infections
What are the 2 primary viruses thought to cause MS?
EBV and HHV-6
Geographically, where is MS more common?
In temperate climates such as northern europe and US/Canada
When is the age of onset for MS?
Highest between 25-35
Is MS more prevalent in men or women?
Women (2:1)
What genetic risk factor has the highest assoiciation with MS?
HLA-DRB1501 (MHC II)
What is the overal risk for MS in the US?

For first degree relatives/fraternal twins?

Identical Twins?
US: 0.1%

1st degree / fraternal: 4%

Identical twins: 30%
What is the most common progression/presentation of MS?
With RRMS (relapsing-remitting MS) signs and symptoms
How do the remainder of MS patients present?
Primary progressive MS
What are 5 typical MS symptoms?
1. Focal Weakness (UMN signs)

2. Focal numbness / paresthesias

3. Coordination problems / tremors

4. Speech problems

5. Spastic Bladder
What is the first step in the pathogenesis of MS?
Early demyelination that progress through an acute/subacute inflammatory phase with axonal injury, cellular infiltration (T cells/macrophages), and later glial scarring.
Do MS lesions respect vascular boundaries/distributions?
NO
Are MS lesions well demarcated?
YES
A CEL (contrast enhancing lesion) that shows up on Gadolinium enhancing MRI indicates what?
Acute inflammation (lesion)
Dark spots in a T1 (black holes) represent what?
Chronic lesions, permanent scar
What are the major steps in the pathogenesis of MS?
1. Immune activation of T/B cells (via poorly defined mechanisms) in PERIPHERY

2. B/T cells enter CNS

3. B/T cells activate resident CNS cells which attack self via MOLECULAR MIMICRY
What are the main distinct lesion patterns in "acute" MS?
Type 1/2: Perivenular myelin loss W/ preservation of oligodendrocytes. 2 has IgG/complement deposition

Type 3/4: Myelin loss NOT perivenular w/ NO preservation of oligodendrocytes

Both have macrophage and T cell infiltration
Within a single patient, are all lesions the same?

Between patients?
ALL SAME w/ in single patient

Different between different patients
MRI findings of "Dawson's Fingers" indicates what type of lesion?
Perivenular demyelination (Type I/II lesion)
What is the main immune cell in the inflammatory mechanism of MS?
T cells
What is thought to be the underlying neuropathological cause for progressive disability in MS patients?
Axonal transection/neuronal loss
Classical symptoms of MS are referable to what?
Dysfunction of White matter tracts
With regard to vision, what is often seen in MS?
Internuclear Opthalmoparesis (Patients can't move eyes together)

Caused by dysfunction of MLF
FLAIR/hyperintense MS lesion suggest what?
Periventricular lesion (Dawson's Fingers)
What can be seen wrt MS on a T2 MRI?
Subacute and chronic plaques
What can be seen wrt MS on a T1 MRI?
Black holes - chronic lesions
What can be seen on a gadolinium contrast MRI?
Acute plaques
Does MS characteristically have long or short cord lesions when detected by MRI?
Short - <2 vertebral body segments
Black holes on T1 indicate what?
glial scarring in an area of axonal loss
What type of lesion is strongly associated with MS disability?
Black holes
Apart from MRIs, what other tests can be used to detect demylinating lesions?
Evoked potential - test for nerve conduction velocities in the CNS
What, while not specific for MS, is found in 80-90% of patients with MS?
Oligoclonal IgG bands - represent CNS immune response