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FACTS
Most common disabling condition in young adults Most common demyelinating disorder Chronic disease of the CNS
DEFINITION
EPIDEMIOLOGY(1)
EPIDEMIOLOGY(2)
Risk is increasing with the latitude
Female dominance (F:M=2:1)
ETIOLOGY(1)
Still unknown!
ETIOLOGY(2)
Multifactory:
Autoimmune(myelin antibody)
Genetics---no clear-cut pattern of inheritance,
PATHOLOGY(1)
PATHOLOGY(2)
Perivascular inflammation and demyelination
Cerebellum
Spinal cord
PATHOLOGY(3)
S clerosis----plaques
PATHOLOGY(4)
Degenerative changes in myelin
CLINICAL FEATURES
PPt :infection, fatigue, delivery a baby Initial symptoms:
Impaired vision Disequilibrium Heat intolerance Problems with bladder control Sensory disturbance Motor weakness
Initial symptoms indicate the site of onset
SENSORY DISTURBANCES
Ascending numbness starting in feet Bilateral hand numbness Hemiparesthesia/dysesthesia Dorsal column signs
Loss of vibration/proprioception
Lhermittes sign
VISION DISTURBANCE
Unilateral or bilateral partial/complete internuclear ophthalmoplegia Optic neuritis
MOTOR DISTURBANCE
Weakness
Pathologic signs
(Babinski, Chaddock, Hoffman)
Dysarthria
OTHER SYMPTOMS
Urinary incontinence,
incomplete emptying
Cognitive and emotional abnormalities (depression, anxiety, emotional lability) Fatigue
Sexual dysfunction
INVESTIGATIONS
CSF MRI
Blood and urine(non-specific)
(Oligoclonal bands)
Evoked potentials(VEP,BREP,SSEP)
MRI
Most useful tool in diagnosis MRI is abnormal in 90% of definite MS Gadolinium enhancement identifies active lesions Lesions abutting central ventricles, with diameter of >0.6 cm,in the posterior fossa, help to diagnose MS
MRIcerebellum
MRIoptic nerve
MRIcerebral hemisphere
MRIspinal cord
Diagnostic criteria
Clinical definite MS (CDMS): two times of attack and two lesions; two attacks, one lesion and one subclinical evidence; Laboratory supported definite MS (LSDMS): Two attacks, one subclinical evidence and CSF /OB/IgG; One attack, two lesions and CSF OB/IgG ; One attack , one lesion, one subclinical evidence and CSF OB/IgG;
Diagnostic criteria
Clinical probable MS (CPMS):
two attacks, one lesion ; one attack, two lesions ; one attack, one lesion and
subclinical evidence;
other
Laboratory supported probable MS (LSPMS) Two attacks ; CSF OB/IgG; Two attacks involving different part of CNS,
intermission at lest one month ; each attack must continue for 24hs.
Treatment--acute
Immunotherapy with steroids or ACTH
Prognosis
EXTREMELY VARIABLE
Thank you!