This document discusses demyelinating diseases of the nervous system, specifically focusing on multiple sclerosis (MS). It provides details on the structure and function of myelin sheaths, describes different types of demyelinating diseases including genetic myelinopathies and autoimmune myelinoclasthies like MS. It discusses the epidemiology, pathogenesis, clinical forms and manifestations of MS, including characteristic signs like retrobulbar neuritis, internuclear ophthalmoplegia, and Lhermitte's sign. MRI images of MS lesions in the brain and spinal cord are also included.
This document provides an overview of demyelinating diseases of the central nervous system, with a focus on multiple sclerosis. It discusses the etiology, pathogenesis, clinical features, diagnosis, treatment and management of multiple sclerosis. Key points include: MS results from an autoimmune attack on the myelin sheath surrounding nerves in the brain and spinal cord; diagnosis involves evidence of lesions disseminated in space and time via MRI or other tests; and treatments include steroids for acute attacks and disease-modifying drugs such as interferons to reduce relapse rates long-term.
Motor neuron disease (MND) refers to conditions characterized by degeneration of upper and lower motor neurons. Amyotrophic lateral sclerosis (ALS) is the most common form of MND and involves both upper and lower motor neurons. ALS is clinically defined based on involvement of motor neurons and includes features such as muscle weakness, atrophy, fasciculations, and stiffness. The pathology of ALS involves degeneration and death of motor neurons in the brain, brainstem, and spinal cord leading to muscle denervation and atrophy. While the cause of ALS is largely unknown, factors such as oxidative stress, protein aggregation, mitochondrial dysfunction, and glutamate excitotoxicity are hypothesized to contribute to motor neuron de
Multiple Sclerosis (MS) is a disease of the central nervous system where the myelin sheaths that surround nerve fibers are damaged, causing communication problems between the brain and body. It is an autoimmune disease where the immune system attacks the myelin for unknown reasons. Symptoms vary between patients but can include vision problems, weakness, fatigue, and cognitive issues. MS is diagnosed through neurological exams, MRI imaging showing lesions on the myelin, and ruling out other potential causes. While there is no cure, treatments aim to reduce symptoms and attacks through medications, therapy, and lifestyle changes.
This document provides information on Multiple Sclerosis (MS), including its epidemiology, etiology, clinical presentation, diagnostic tests, disease course, and treatment options. MS is an immune-mediated disease that attacks the central nervous system, destroying myelin and axons. Common symptoms include visual changes, numbness, weakness, and balance issues. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and evoked potentials testing. The disease course varies between relapsing-remitting, primary progressive, and secondary progressive forms. Treatment focuses on reducing inflammation and disability through medications like interferon beta, glatiramer acetate, and natalizumab, as well as managing symptoms with drugs for pain,
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
Essential tremor is a common condition characterized by bilateral, fast, low amplitude tremors mainly in the upper limbs that are often inherited and worsened by anxiety. It causes postural tremors when holding objects. Huntington's disease is a cause of chorea that presents in middle life with initial subtle movements and later psychiatric and cognitive symptoms due to a CAG trinucleotide repeat expansion. Tourette's syndrome is the most common cause of tics, characterized by multiple motor and at least one vocal tic starting in childhood and persisting over a year, affecting boys more than girls and associated with behavioral problems and disorders like ADHD and OCD.
This document discusses myelin, its composition and function. It describes how myelin forms a sheath around neurons, insulating them and allowing rapid nerve impulse propagation. Cholesterol and proteins like myelin basic protein are important myelin components. Myelination begins in fetal development and continues through life. Diseases like multiple sclerosis involve demyelination through autoimmune or other processes. The document examines MS in terms of epidemiology, pathogenesis, clinical presentation and investigations like CSF analysis and MRI that are used in diagnosis.
Dementia can sometimes be caused by reversible conditions. This document discusses several potential reversible causes of dementia, including thyroid disorders, vitamin deficiencies, infections, and side effects of medications like steroids. It provides details on specific disorders and how treatment of the underlying condition may resolve cognitive and behavioral symptoms. Reversible dementias are estimated to account for 18% of cases under 65 but only 5% of those over 65. While treatment can sometimes improve symptoms, complete reversion of cognitive impairment is unclear for certain conditions like Cushing's syndrome.
This document provides an overview of demyelinating diseases of the central nervous system, with a focus on multiple sclerosis. It discusses the etiology, pathogenesis, clinical features, diagnosis, treatment and management of multiple sclerosis. Key points include: MS results from an autoimmune attack on the myelin sheath surrounding nerves in the brain and spinal cord; diagnosis involves evidence of lesions disseminated in space and time via MRI or other tests; and treatments include steroids for acute attacks and disease-modifying drugs such as interferons to reduce relapse rates long-term.
Motor neuron disease (MND) refers to conditions characterized by degeneration of upper and lower motor neurons. Amyotrophic lateral sclerosis (ALS) is the most common form of MND and involves both upper and lower motor neurons. ALS is clinically defined based on involvement of motor neurons and includes features such as muscle weakness, atrophy, fasciculations, and stiffness. The pathology of ALS involves degeneration and death of motor neurons in the brain, brainstem, and spinal cord leading to muscle denervation and atrophy. While the cause of ALS is largely unknown, factors such as oxidative stress, protein aggregation, mitochondrial dysfunction, and glutamate excitotoxicity are hypothesized to contribute to motor neuron de
Multiple Sclerosis (MS) is a disease of the central nervous system where the myelin sheaths that surround nerve fibers are damaged, causing communication problems between the brain and body. It is an autoimmune disease where the immune system attacks the myelin for unknown reasons. Symptoms vary between patients but can include vision problems, weakness, fatigue, and cognitive issues. MS is diagnosed through neurological exams, MRI imaging showing lesions on the myelin, and ruling out other potential causes. While there is no cure, treatments aim to reduce symptoms and attacks through medications, therapy, and lifestyle changes.
This document provides information on Multiple Sclerosis (MS), including its epidemiology, etiology, clinical presentation, diagnostic tests, disease course, and treatment options. MS is an immune-mediated disease that attacks the central nervous system, destroying myelin and axons. Common symptoms include visual changes, numbness, weakness, and balance issues. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and evoked potentials testing. The disease course varies between relapsing-remitting, primary progressive, and secondary progressive forms. Treatment focuses on reducing inflammation and disability through medications like interferon beta, glatiramer acetate, and natalizumab, as well as managing symptoms with drugs for pain,
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
Essential tremor is a common condition characterized by bilateral, fast, low amplitude tremors mainly in the upper limbs that are often inherited and worsened by anxiety. It causes postural tremors when holding objects. Huntington's disease is a cause of chorea that presents in middle life with initial subtle movements and later psychiatric and cognitive symptoms due to a CAG trinucleotide repeat expansion. Tourette's syndrome is the most common cause of tics, characterized by multiple motor and at least one vocal tic starting in childhood and persisting over a year, affecting boys more than girls and associated with behavioral problems and disorders like ADHD and OCD.
This document discusses myelin, its composition and function. It describes how myelin forms a sheath around neurons, insulating them and allowing rapid nerve impulse propagation. Cholesterol and proteins like myelin basic protein are important myelin components. Myelination begins in fetal development and continues through life. Diseases like multiple sclerosis involve demyelination through autoimmune or other processes. The document examines MS in terms of epidemiology, pathogenesis, clinical presentation and investigations like CSF analysis and MRI that are used in diagnosis.
Dementia can sometimes be caused by reversible conditions. This document discusses several potential reversible causes of dementia, including thyroid disorders, vitamin deficiencies, infections, and side effects of medications like steroids. It provides details on specific disorders and how treatment of the underlying condition may resolve cognitive and behavioral symptoms. Reversible dementias are estimated to account for 18% of cases under 65 but only 5% of those over 65. While treatment can sometimes improve symptoms, complete reversion of cognitive impairment is unclear for certain conditions like Cushing's syndrome.
This document provides an overview of frontotemporal dementia (FTD) including its causes, clinical presentation, diagnosis, and management options. It discusses that FTD is caused by protein misfolding and accumulation in the brain. There are three main clinical variants - behavioral variant FTD, semantic dementia, and progressive nonfluent aphasia. Diagnosis involves ruling out other causes and may include brain imaging. Treatment focuses on managing symptoms but medications have limited effectiveness. Caregiver burden can be high due to patient behaviors, so support groups are recommended.
Multiple sclerosis is a progressive disease of the central nervous system where communication between the brain and body is disrupted. It is caused by damage to the protective myelin sheath covering the nerves, which can affect functions throughout the body. While MS was first diagnosed in the 19th century, there is no definitive test and diagnosis involves evaluating symptoms, medical history, and use of tests like MRI and evoked potentials to detect lesions in the brain and spinal cord. The disease typically appears between ages 20-40 and can range from mild to severe. There are several types but most common is relapsing-remitting MS where symptoms flare up and then decrease. Currently there is no cure but treatments can help manage symptoms and slow progression.
This document summarizes multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the central nervous system. It discusses the etiology, pathology, clinical presentation, imaging features, diagnostic criteria, variants, and differential diagnosis of MS. Key points include: MS is characterized by inflammatory demyelinating lesions ("plaques") in the brain and spinal cord; risk factors include genetic and environmental factors; clinical presentation varies from relapsing-remitting to progressive forms; MRI is important for diagnosis and demonstrates disseminated hyperintense lesions; and differential diagnosis includes ADEM, Susac syndrome, and CNS tumors.
Here is very good and amazing presentation on Multiple sclerosis ..its about brain
read this carefully and work on this because the work on brain is very good for future research...
This document provides information about Multiple Sclerosis (MS). It defines MS as a chronic neurological disorder that affects the central nervous system, where myelin is destroyed in the brain and spinal cord, causing scarring in multiple sites. MS is the most common disabling condition in young adults. While its cause is unknown, it involves an immunological reaction destroying myelin. Symptoms vary between patients and can include vision changes, numbness, weakness, and problems with coordination or bladder control. Diagnosis involves MRI imaging and other tests. Currently, there is no cure for MS but treatments can help reduce symptoms and slow progression.
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system through inflammation and demyelination. It is more common in women than men and typically occurs in young adults between 20-40 years old. MS is predominantly found in northern regions of the world. While its cause is unknown, genetic and environmental factors like infections are thought to play a role. Symptoms vary depending on the areas of the nervous system affected but can include vision problems, impaired movement, sensory issues, and mental changes. The disease progresses over time and treatment aims to manage symptoms and reduce inflammation.
Multiple sclerosis is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and scarring of the nervous tissue. It can present as either relapsing-remitting or progressive forms. Lesions vary in size and are typically disseminated throughout the white matter of the brain and spinal cord. Diagnosis involves demonstrating dissemination of lesions in time and space through clinical examination, evoked potentials, MRI, and CSF analysis. Treatment involves steroids for acute attacks and disease-modifying therapies such as interferons or glatiramer acetate for relapsing forms.
This document provides guidelines for the diagnosis and treatment of multiple sclerosis (MS). It discusses the different subtypes of MS, diagnostic criteria, disease mechanisms, epidemiology in India, clinical features of relapses, and guidelines for using disease-modifying therapies. Key recommendations include using McDonald criteria for diagnosis, treating relapsing forms of MS with approved disease-modifying drugs, monitoring patients on treatment, and considering ocrelizumab for primary progressive MS.
This document provides an overview of neuromyelitis optica spectrum disorders (NMOSD). It discusses the epidemiology, clinical features, diagnostic criteria, investigations, neuroimaging findings, and treatments for NMOSD. Key points include that NMOSD predominantly affects the optic nerves and spinal cord, is strongly associated with antibodies against the aquaporin-4 protein, and treatments involve high-dose steroids, plasma exchange, or intravenous immunoglobulins for acute exacerbations. The diagnostic criteria were revised in 2015 to incorporate aquaporin-4 antibody testing and distinguish NMOSD from multiple sclerosis.
This document provides an overview of peripheral neuropathy, including:
1. It describes the anatomy of peripheral nerves and different types of peripheral neuropathies such as mononeuropathy, mononeuropathy multiplex, polyneuropathy, polyradiculopathy, and plexopathy.
2. It outlines the various clinical presentations of peripheral neuropathy including sensory, motor, and autonomic symptoms as well as patterns of nerve fiber involvement.
3. It discusses the etiology, clinical course, investigations and management of different peripheral neuropathies.
Upper motor neurons convey impulses for voluntary motor activity and exert control over lower motor neurons, which directly innervate skeletal muscle. Upper motor neuron cell bodies are located in the motor cortex and premotor areas. Their axons form tracts that project to lower motor neurons in the brainstem and spinal cord. Lower motor neuron cell bodies are located in the brainstem and spinal cord. Damage to upper motor neurons results in spasticity and hyperreflexia, while lower motor neuron damage causes weakness, atrophy, fasciculations and hyporeflexia. Amyotrophic lateral sclerosis is a motor neuron disorder characterized by both upper and lower motor neuron degeneration.
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS , the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.
Amyotrophic lateral sclerosis (ALS) is a rare neurological disease that primarily affects the nerve cells (neurons) responsible for controlling voluntary muscle movement (those muscles we choose to move). Voluntary muscles produce movements like chewing, walking, and talking.
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by breakdown of the myelin sheath covering nerve axons. It affects over 400,000 people in the US and more than 2.1 million worldwide. Genetic factors, autoimmunity, infection, vitamin D levels, and loss of protective childhood infections may play a role in MS etiology. Clinically, MS presents with a variety of neurological symptoms depending on the location of lesions in the brain and spinal cord, including visual, motor, sensory and cognitive impairments. Disease courses include relapsing-remitting MS, secondary progressive MS, primary progressive MS and progressive-relapsing MS.
Multiple Sclerosis (MS) is an autoimmune disease where the body's immune system attacks the protective myelin sheath surrounding the nerves. It is a lifelong disease with no known cure. Common symptoms include fatigue, weakness, numbness, vision problems, and cognitive issues. While there is no single known cause, genetic and environmental factors such as latitude, infections, and family history are associated with increased risk. Diagnosis involves ruling out other conditions through clinical evaluation and tests such as MRI and lumbar puncture. Treatment focuses on managing symptoms and reducing relapse rate through medications, while rehabilitation and alternative therapies can also help those affected cope with the disease.
1) Alzheimer's disease is a progressive brain disorder that causes memory loss and cognitive decline. It is the most common type of dementia.
2) The symptoms of Alzheimer's disease include cognitive dysfunction like memory loss as well as non-cognitive symptoms like depression, behavioral changes, and impaired daily living. Memory loss is usually the first symptom.
3) The pathology of Alzheimer's disease involves amyloid plaques and neurofibrillary tangles in the brain as well as loss of connections between neurons. It progresses from mild to moderate and severe forms with further cognitive and functional impairment.
1. Multiple sclerosis is a disease of the central nervous system where the protective myelin sheath around the axons is damaged, leading to scarring and demyelination.
2. It commonly affects people between the ages of 20-40 and has a higher prevalence in northern European populations and temperate climates.
3. Symptoms vary widely and can include changes in sensation, vision problems, weakness, and balance issues. Diagnosis involves MRI imaging and ruling out other potential causes through blood and spinal fluid tests.
Motor neuron disease - Etiology, Pathogenesis, Clinical Features, Classificat...Chetan Ganteppanavar
This document discusses motor neuron diseases, including amyotrophic lateral sclerosis (ALS). It provides details on the classification, symptoms, signs, diagnosis, prognosis, and management of ALS and related conditions. Key points include that ALS is characterized by the degeneration of both upper and lower motor neurons, leading to muscle weakness, atrophy, and fasciculations. Diagnosis involves finding signs of both upper and lower motor neuron involvement. Prognosis is typically worse if onset is bulbar or simultaneous in multiple limbs. Treatment focuses on managing symptoms while no treatments have been proven to slow disease progression.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document discusses the differential diagnosis and clinical presentation of acute flaccid paralysis. It covers various central nervous system, peripheral nerve, neuromuscular junction, and muscle disorders that can cause acute flaccid paralysis. Specific conditions discussed in detail include transverse myelitis, Guillain-Barré syndrome, myasthenia gravis, spinal muscular atrophy, and poliomyelitis. The document also provides information on the genetic testing, clinical classification, and typical features of spinal muscular atrophy.
This document provides an overview of frontotemporal dementia (FTD) including its causes, clinical presentation, diagnosis, and management options. It discusses that FTD is caused by protein misfolding and accumulation in the brain. There are three main clinical variants - behavioral variant FTD, semantic dementia, and progressive nonfluent aphasia. Diagnosis involves ruling out other causes and may include brain imaging. Treatment focuses on managing symptoms but medications have limited effectiveness. Caregiver burden can be high due to patient behaviors, so support groups are recommended.
Multiple sclerosis is a progressive disease of the central nervous system where communication between the brain and body is disrupted. It is caused by damage to the protective myelin sheath covering the nerves, which can affect functions throughout the body. While MS was first diagnosed in the 19th century, there is no definitive test and diagnosis involves evaluating symptoms, medical history, and use of tests like MRI and evoked potentials to detect lesions in the brain and spinal cord. The disease typically appears between ages 20-40 and can range from mild to severe. There are several types but most common is relapsing-remitting MS where symptoms flare up and then decrease. Currently there is no cure but treatments can help manage symptoms and slow progression.
This document summarizes multiple sclerosis (MS), a chronic inflammatory demyelinating disease of the central nervous system. It discusses the etiology, pathology, clinical presentation, imaging features, diagnostic criteria, variants, and differential diagnosis of MS. Key points include: MS is characterized by inflammatory demyelinating lesions ("plaques") in the brain and spinal cord; risk factors include genetic and environmental factors; clinical presentation varies from relapsing-remitting to progressive forms; MRI is important for diagnosis and demonstrates disseminated hyperintense lesions; and differential diagnosis includes ADEM, Susac syndrome, and CNS tumors.
Here is very good and amazing presentation on Multiple sclerosis ..its about brain
read this carefully and work on this because the work on brain is very good for future research...
This document provides information about Multiple Sclerosis (MS). It defines MS as a chronic neurological disorder that affects the central nervous system, where myelin is destroyed in the brain and spinal cord, causing scarring in multiple sites. MS is the most common disabling condition in young adults. While its cause is unknown, it involves an immunological reaction destroying myelin. Symptoms vary between patients and can include vision changes, numbness, weakness, and problems with coordination or bladder control. Diagnosis involves MRI imaging and other tests. Currently, there is no cure for MS but treatments can help reduce symptoms and slow progression.
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system through inflammation and demyelination. It is more common in women than men and typically occurs in young adults between 20-40 years old. MS is predominantly found in northern regions of the world. While its cause is unknown, genetic and environmental factors like infections are thought to play a role. Symptoms vary depending on the areas of the nervous system affected but can include vision problems, impaired movement, sensory issues, and mental changes. The disease progresses over time and treatment aims to manage symptoms and reduce inflammation.
Multiple sclerosis is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and scarring of the nervous tissue. It can present as either relapsing-remitting or progressive forms. Lesions vary in size and are typically disseminated throughout the white matter of the brain and spinal cord. Diagnosis involves demonstrating dissemination of lesions in time and space through clinical examination, evoked potentials, MRI, and CSF analysis. Treatment involves steroids for acute attacks and disease-modifying therapies such as interferons or glatiramer acetate for relapsing forms.
This document provides guidelines for the diagnosis and treatment of multiple sclerosis (MS). It discusses the different subtypes of MS, diagnostic criteria, disease mechanisms, epidemiology in India, clinical features of relapses, and guidelines for using disease-modifying therapies. Key recommendations include using McDonald criteria for diagnosis, treating relapsing forms of MS with approved disease-modifying drugs, monitoring patients on treatment, and considering ocrelizumab for primary progressive MS.
This document provides an overview of neuromyelitis optica spectrum disorders (NMOSD). It discusses the epidemiology, clinical features, diagnostic criteria, investigations, neuroimaging findings, and treatments for NMOSD. Key points include that NMOSD predominantly affects the optic nerves and spinal cord, is strongly associated with antibodies against the aquaporin-4 protein, and treatments involve high-dose steroids, plasma exchange, or intravenous immunoglobulins for acute exacerbations. The diagnostic criteria were revised in 2015 to incorporate aquaporin-4 antibody testing and distinguish NMOSD from multiple sclerosis.
This document provides an overview of peripheral neuropathy, including:
1. It describes the anatomy of peripheral nerves and different types of peripheral neuropathies such as mononeuropathy, mononeuropathy multiplex, polyneuropathy, polyradiculopathy, and plexopathy.
2. It outlines the various clinical presentations of peripheral neuropathy including sensory, motor, and autonomic symptoms as well as patterns of nerve fiber involvement.
3. It discusses the etiology, clinical course, investigations and management of different peripheral neuropathies.
Upper motor neurons convey impulses for voluntary motor activity and exert control over lower motor neurons, which directly innervate skeletal muscle. Upper motor neuron cell bodies are located in the motor cortex and premotor areas. Their axons form tracts that project to lower motor neurons in the brainstem and spinal cord. Lower motor neuron cell bodies are located in the brainstem and spinal cord. Damage to upper motor neurons results in spasticity and hyperreflexia, while lower motor neuron damage causes weakness, atrophy, fasciculations and hyporeflexia. Amyotrophic lateral sclerosis is a motor neuron disorder characterized by both upper and lower motor neuron degeneration.
Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS , the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.
Amyotrophic lateral sclerosis (ALS) is a rare neurological disease that primarily affects the nerve cells (neurons) responsible for controlling voluntary muscle movement (those muscles we choose to move). Voluntary muscles produce movements like chewing, walking, and talking.
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by breakdown of the myelin sheath covering nerve axons. It affects over 400,000 people in the US and more than 2.1 million worldwide. Genetic factors, autoimmunity, infection, vitamin D levels, and loss of protective childhood infections may play a role in MS etiology. Clinically, MS presents with a variety of neurological symptoms depending on the location of lesions in the brain and spinal cord, including visual, motor, sensory and cognitive impairments. Disease courses include relapsing-remitting MS, secondary progressive MS, primary progressive MS and progressive-relapsing MS.
Multiple Sclerosis (MS) is an autoimmune disease where the body's immune system attacks the protective myelin sheath surrounding the nerves. It is a lifelong disease with no known cure. Common symptoms include fatigue, weakness, numbness, vision problems, and cognitive issues. While there is no single known cause, genetic and environmental factors such as latitude, infections, and family history are associated with increased risk. Diagnosis involves ruling out other conditions through clinical evaluation and tests such as MRI and lumbar puncture. Treatment focuses on managing symptoms and reducing relapse rate through medications, while rehabilitation and alternative therapies can also help those affected cope with the disease.
1) Alzheimer's disease is a progressive brain disorder that causes memory loss and cognitive decline. It is the most common type of dementia.
2) The symptoms of Alzheimer's disease include cognitive dysfunction like memory loss as well as non-cognitive symptoms like depression, behavioral changes, and impaired daily living. Memory loss is usually the first symptom.
3) The pathology of Alzheimer's disease involves amyloid plaques and neurofibrillary tangles in the brain as well as loss of connections between neurons. It progresses from mild to moderate and severe forms with further cognitive and functional impairment.
1. Multiple sclerosis is a disease of the central nervous system where the protective myelin sheath around the axons is damaged, leading to scarring and demyelination.
2. It commonly affects people between the ages of 20-40 and has a higher prevalence in northern European populations and temperate climates.
3. Symptoms vary widely and can include changes in sensation, vision problems, weakness, and balance issues. Diagnosis involves MRI imaging and ruling out other potential causes through blood and spinal fluid tests.
Motor neuron disease - Etiology, Pathogenesis, Clinical Features, Classificat...Chetan Ganteppanavar
This document discusses motor neuron diseases, including amyotrophic lateral sclerosis (ALS). It provides details on the classification, symptoms, signs, diagnosis, prognosis, and management of ALS and related conditions. Key points include that ALS is characterized by the degeneration of both upper and lower motor neurons, leading to muscle weakness, atrophy, and fasciculations. Diagnosis involves finding signs of both upper and lower motor neuron involvement. Prognosis is typically worse if onset is bulbar or simultaneous in multiple limbs. Treatment focuses on managing symptoms while no treatments have been proven to slow disease progression.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document discusses the differential diagnosis and clinical presentation of acute flaccid paralysis. It covers various central nervous system, peripheral nerve, neuromuscular junction, and muscle disorders that can cause acute flaccid paralysis. Specific conditions discussed in detail include transverse myelitis, Guillain-Barré syndrome, myasthenia gravis, spinal muscular atrophy, and poliomyelitis. The document also provides information on the genetic testing, clinical classification, and typical features of spinal muscular atrophy.
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system through inflammation and demyelination. It is more common in women than men and typically occurs in young adults between 20-40 years old. MS is predominantly found in northern regions of the world. While its cause is unknown, genetic and environmental factors like infections are thought to play a role. Symptoms vary depending on the areas of the nervous system affected but can include vision problems, impaired movement, sensory issues, and mental changes. MS is diagnosed based on symptoms and examinations and has varying degrees of severity.
The document discusses multiple sclerosis (MS), including its anatomy, physiology, pathogenesis, types, symptoms, diagnosis and treatment. MS is a chronic inflammatory demyelinating disease of the central nervous system. It results from an immune-mediated process causing inflammation, demyelination and axonal loss. There are four main types but the most common is relapsing remitting MS, characterized by temporary flare-ups followed by periods of remission. Symptoms vary depending on location of lesions but may include sensory issues, weakness, visual problems, coordination difficulties and more. Diagnosis involves clinical criteria and tests like MRI and lumbar puncture. Treatment focuses on managing relapses, reducing disease activity and controlling symptoms.
This document discusses multiple sclerosis and other inflammatory demyelinating diseases. It begins by classifying these diseases and then provides more detailed information about multiple sclerosis, including its history, prevalence, epidemiology, risk factors, pathogenesis, pathology, clinical features, disease course, and diagnosis. Multiple sclerosis is an autoimmune disease characterized by chronic inflammation, demyelination, and neuronal loss that typically affects the central nervous system in a disseminated manner.
Multiple sclerosis is a disease that destroys myelin in the central nervous system. It most commonly affects people between 20-40 years old. The disease has an uneven global distribution and both genetic and environmental factors influence risk. Symptoms vary depending on location of lesions in the brain and spinal cord but may include visual issues, motor problems, sensory changes, and more. The disease typically follows a relapsing-remitting course with exacerbations followed by periods of remission or stabilization. Diagnosis involves ruling out other possibilities and may include MRI, lumbar puncture, and examination of symptoms and clinical course.
Motor neuron diseases (MNDs) are a group of progressive neurological disorders that predominantly or exclusively affect upper motor neurons, lower motor neurons, or both. There are several classifications of MND including sporadic or inherited forms, and those involving combined upper and lower motor neuron involvement (such as amyotrophic lateral sclerosis), pure lower motor neuron involvement (such as spinal muscular atrophy), or pure upper motor neuron involvement (such as primary lateral sclerosis). Common clinical features include muscle weakness, wasting, and fasciculations depending on the type and location of motor neuron involvement. Investigations help differentiate MNDs from other conditions and there is currently no cure, though some treatments can help manage symptoms.
The document discusses multiple sclerosis (MS), including its types, causes, pathophysiology, clinical manifestations, diagnosis, investigations, treatment, and management through a case study. It describes how MS is caused by the immune system attacking the myelin sheath surrounding nerves. There are four main types of MS: clinically isolated syndrome, relapsing-remitting MS, secondary progressive MS, and primary progressive MS. Diagnosis involves medical history, MRI, neurological exam, and lumbar puncture. Treatment focuses on reducing inflammation and managing symptoms, though there is no cure currently.
A brief description about Demyelination topics by Dr Sabu Augustine for MBBS Students in Medical school.
References from textbooks and other presentations.
Multiple sclerosis (MS) is a chronic disease that damages the central nervous system. Dr. Jean Charcot first defined MS in 1868 by identifying characteristic clinical and pathological findings. MS typically onset between ages 15-50 and is more common in women. Symptoms vary greatly between individuals and over time, and can include problems with vision, sensation, motor function, coordination, bladder control, cognition and more. Treatment aims to manage symptoms and prevent disability progression.
Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system characterized by inflammation, demyelination, axonal loss and gliosis. It is considered an autoimmune disease where the body's immune system attacks the protective myelin sheath surrounding the nerves. There are several types including relapsing-remitting MS where patients experience clearly defined attacks followed by periods of remission, primary progressive MS where symptoms worsen from the onset without remission, and secondary progressive MS where an initial relapsing-remitting course transitions to progressive worsening over time. Symptoms vary between patients and over time but can include sensory impairment, visual impairment, motor impairment, cognitive issues, and bladder/bowel
This case report describes a young female patient with a diagnosis of multiple sclerosis (MS). She initially presented at age 2 with ataxia. MRI of the brain showed widespread white matter lesions. She had two relapses over the next 8 months with new neurological symptoms and MRI lesions each time. Differential diagnoses considered included acute disseminated encephalomyelitis (ADEM) but she did not meet criteria. Her disease course and imaging supported a diagnosis of pediatric MS. She was treated with steroids during relapses with clinical improvement.
Multiple Sclerosis And The Central Nervous SystemAmanda Brady
Multiple sclerosis is an autoimmune disease that affects the central nervous system, including the brain and spinal cord. It causes damage to the myelin sheath that surrounds nerve fibers, which can impair nerve signals. There is currently no cure for MS, but treatments can help suppress symptoms and slow progression. The disease is characterized by different types defined by periods of relapse and remission. Neurons transmit signals throughout the body, and damage from MS can disrupt these signals and cause issues like fatigue, vision problems, and mobility issues.
This document discusses demyelinating diseases, specifically multiple sclerosis. It describes the key features of MS, including that it is a chronic disease characterized by episodes of focal neurological disorders that remit and recur over many years. The diagnosis can be uncertain early on but becomes more accurate as lesions disseminate throughout the central nervous system. The document outlines the pathogenesis of MS, which involves an autoimmune reaction triggered by viral infection that results in destruction of the myelin sheath. Diagnostics include examination of cerebrospinal fluid and MRI of the brain and spine to detect lesions. Variants such as acute disseminated encephalomyelitis are also mentioned.
1) Myelin forms a protective sheath around neurons and is produced by glial cells. It allows for rapid saltatory conduction of nerve impulses.
2) Demyelination can result from autoimmune, infectious, toxic, or vascular causes and leads to diseases like multiple sclerosis. MS is characterized by episodes of focal neurological deficits that remit and recur over time.
3) MS typically presents in young adults and is more common in women. It has a variable clinical course but often involves optic neuritis, transverse myelitis, cerebellar signs, or brainstem symptoms initially. Established MS can cause mixed motor, sensory and cognitive impairments.
This document discusses neurodegenerative, demyelinating, and obstructive diseases. It defines neurodegenerative diseases as disorders characterized by the progressive loss of neurons. Examples include Alzheimer's disease and Parkinson's disease. Multiple sclerosis is provided as an example of a demyelinating disease characterized by damage to myelin. Hydrocephalus is defined as the abnormal dilation of the ventricular system due to excess cerebrospinal fluid, and examples of causes include congenital abnormalities and obstructions that inhibit cerebrospinal fluid flow or absorption.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system where the body's immune system attacks the protective myelin sheath surrounding the nerves. It most commonly affects people between 20-40 years of age. While the exact cause is unknown, genetic and environmental factors are thought to play a role. The four main types are relapsing-remitting MS, primary-progressive MS, progressive-relapsing MS, and secondary-progressive MS. Symptoms vary depending on the affected areas of the brain and spinal cord but may include vision issues, weakness, numbness, and problems with coordination and balance. Diagnosis involves neurological exams, MRI scans and analysis of cerebrospinal fluid
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. It occurs when the immune system attacks the protective myelin sheath surrounding nerve fibers. Common symptoms include vision problems, muscle weakness, numbness, and fatigue. It is typically diagnosed based on symptoms, neurological exams, and imaging tests like MRI. The most common form is relapsing-remitting MS, where periods of exacerbation are followed by periods of remission. While there is no cure for MS, treatments can help manage symptoms and reduce relapses.
This document provides information on multiple sclerosis (MS) including:
- MS is a chronic, often disabling disease that attacks the central nervous system including the brain, spinal cord, and optic nerves.
- Symptoms can range from mild numbness to severe paralysis or vision loss and vary between individuals unpredictably.
- New treatments and research advances are providing hope for those affected by the disease.
Personality disorder and mental retardation.Kapil Dhital
This document discusses various personality disorders and mental retardation. It describes 10 personality disorders grouped into 3 clusters (A, B, C). Cluster A includes paranoid, schizoid and schizotypal disorders. Cluster B includes antisocial, borderline, histrionic and narcissistic disorders. Cluster C includes avoidant, dependent and obsessive-compulsive disorders. It also discusses the essential features, course, prognosis and treatment of each disorder. Mental retardation is defined as innate intellectual deficiency of varying severity based on IQ. Potential causes include genetic, medical and environmental factors.
Chronic tonsillitis refers to chronic inflammation of the palatine tonsils. It is characterized by (1) complaints reported by the patient such as recurring sore throats, (2) disruption of the tonsils' drainage function, and (3) morphological changes seen on histological examination. Compensated chronic tonsillitis presents with no complaints but local signs of inflammation, while decompensated chronic tonsillitis results in frequent sore throats, abscesses, and possible complications affecting other organs. Adenoid hypertrophy involves enlargement of the lymphoid tissue in the nasopharynx and can partially or fully block the nasal cavity, leading to various respiratory, ear, facial, dental, sleep
The document summarizes mood (affective) disorders including bipolar affective disorder, cyclothymia, depression, and treatment options. It also discusses epilepsy including classification of seizures, diagnosis, treatment including medication, surgery and ketogenic diet, and complications like status epilepticus.
This document summarizes schizophrenia, including its etiology, pathogenesis, clinical pictures and types. It discusses potential genetic and environmental predisposing factors. Four main types of schizophrenia are described: paranoid, hebephrenic, catatonic, and simple. Treatment options mentioned include antipsychotic medications, electroconvulsive therapy, psychotherapy, and social/vocational rehabilitation programs.
1) The document discusses diseases of the paranasal sinuses, focusing on sinusitis which is the inflammation of the mucous membrane lining the sinuses.
2) Sinusitis can be acute or chronic and involves inflammation of the maxillary, ethmoidal, frontal, or sphenoid sinuses.
3) Sinusitis is usually caused by infection spreading from the nasal cavity or upper teeth, but may also be due to immunodeficiency, anatomical abnormalities blocking sinus drainage, or changes in sinus secret quality.
The document discusses post-traumatic stress disorder and reactive psychosis. It outlines the diagnostic criteria for post-traumatic stress disorder according to recurrent thoughts, feelings, and behaviors related to a traumatic event. It then describes different types of reactive psychosis including acute, subacute, and prolonged, characterized by states like confusion, stupor, and paranoia that develop following psychological trauma. Treatment involves limiting medications and providing psychological support to alleviate anxiety and discuss the traumatic events.
Peptic ulcer disease is caused by gastric or duodenal ulcers that form lesions in the stomach or duodenal mucosa. Risk factors include H. pylori infection, smoking, NSAID use, and genetic factors. Symptoms include epigastric pain relieved by food and antacids. Treatment aims to relieve pain, eradicate H. pylori infection, heal ulcers, and prevent recurrence through lifestyle changes and medication like PPIs or H2 blockers. Surgery was more common historically but is now rare due to H. pylori treatments, though it may be used for complications like perforation.
The document discusses different types of non-suppurative ear diseases including mucous otitis and serous otitis. Mucous otitis, also called glue ear, is characterized by thick fluid accumulation in the middle ear without inflammation. It commonly affects young children and treatment involves surgical insertion of tubes. Serous otitis involves thin fluid, often due to upper respiratory infections or allergies, and may clear with antihistamines or ear tube insertion. Sensori-neural hearing loss affects the inner ear or auditory nerve and results in impaired hearing without pain or ear discharge.
1) Retraction pockets and atelectasis occur when parts of the eardrum lack an elastic layer, causing the eardrum to retract inward and accumulate debris.
2) Perforations of the eardrum can be central, marginal, or attic. Marginal perforations involve the fibrous annulus and are associated with bone disease and cholesteatoma formation.
3) Chronic otitis media can be non-suppurative (e.g. serous or glue ear) or suppurative (e.g. tubo-tympanic or attico-antral disease), which is more destructive and dangerous.
1. Furunculosis is an infection of the hair follicle in the outer ear that causes pain spreading to the jaw or neck and swelling around the ear.
2. Otitis externa is a generalized infection of the external ear canal caused by irritants like dust or humidity. Symptoms include a painfully inflamed and weeping canal.
3. Wax in the ear can build up and cause hearing loss. It is normally extruded by chewing but may require gentle removal by curette or syringing if excessive.
Psychiatry is a branch of medicine concerned with the study, diagnosis, treatment and prevention of mental disorders. The history of psychiatry developed from a primitive religious understanding of mental illness in ancient times to the modern era of social psychiatry characterized by widespread community mental health services. Psychiatry aims to study and classify mental disorders, investigate their causes and symptoms, and develop effective diagnosis and treatment methods. Common psychiatric treatments include antipsychotics, antidepressants, mood stabilizers, and other psychotropic medications.
The document provides an overview of the anatomy and physiology of the urinary system. It describes the key components including the kidneys, ureters, bladder, and urethra. It explains the functions of the kidneys in filtering waste and regulating fluid balance. It also details the nephron, the functional unit of the kidney, and how it produces urine through glomerular filtration, tubular reabsorption, and secretion.
Rheumatic fever is an inflammatory disease that can affect the heart, joints, blood vessels, and nervous system following a streptococcal infection of the throat or skin. It is most common in children ages 5-15. Symptoms may include fever, joint pain and swelling, involuntary movements (chorea), and heart valve damage. Diagnosis is based on symptoms occurring after a streptococcal infection along with findings on physical exam and tests like echocardiogram and electrocardiogram. Treatment focuses on antibiotics to prevent recurrence as well as medications for symptoms like joint pain, heart failure, and chorea. Damage to heart valves may require long-term antibiotics or valve surgery.
The document provides an overview of the anatomy and physiology of the ear, nose, pharynx, and larynx. It describes the external, middle, and inner parts of the ear. It outlines the structures in the nose including the nasal cavity, septum, turbinates, and paranasal sinuses. It details the three parts of the pharynx and lymphoid tissues. It concludes with the cartilage, spaces, folds and cords that make up the larynx.
The acoustic analyzer examines hearing through three main parts: the peripheral section, pathway, and cortex zone. The peripheral section includes the outer, middle, and inner ear, which conduct and perceive sound. The pathway involves nerves that transmit signals from the inner ear to the brain. The cortex zone in the temporal lobe of the brain is where acoustic information is processed. Hearing can be tested through methods like whisper speech, tuning forks, and audiometry to diagnose conductive, sensorineural, or mixed hearing loss.
The document provides an overview of the anatomy and physiology of the ear and nose. It describes the three parts of the ear - external, middle, and inner - and details the structures within each part such as the pinna, external auditory meatus, eardrum, ossicles, and cochlea. It also describes the anatomy of the nose, including the nasal cavity, septum, turbinates, and paranasal sinuses. Key functions such as olfaction, filtration, humidification are also summarized.
The document discusses fetal malpresentation and malposition, which refer to abnormal positions of the fetus in the uterus. It describes different types of malpresentation including breech, transverse lie, brow, face, and sinciput presentations. It also discusses fetal malpositions including occipitoposterior and occipitotransverse positions. Diagnosis and management approaches are outlined for each type as well as nursing care considerations.
2. LECTURE №8 THEME : Demyelination diseases of nervous system
3. Myelinated axons Most axons are surrounded by a myelin sheath . The myelin sheaths of the central nervous system are composed of the cell membrane of oligodendroglia , which is wrapped around the axon to form a multilaminar structure.
4. The myelin sheath enables the axon to conduct impulses more rapidly; thus, loss of myelin lowers conduction velocity, producing clinical manifestations of neuronal dysfunction. Each layer of a myelin sheath is 7.5 microns thick and is composed of two lipoid and two proteinaceous monomolecular layers . The common feature of all diseases affecting myelin is a pathological abnormality or total destruction of myelin sheaths , primarily in the central nervous system. In the genetic myelinopathies , the primary development of myelin is deficient .
5. B ut, in many cases , myelin is lost later in life, in the metabolic and autoimmune demyelinating diseases . They call this group of demyelinating diseases myelinoclasthies . Myelinopathies : adrenoleikodystrophies, phenylke-tonuria, mitochondrial leukoencephalopathies, leukodys - trophies Krabbe and disease of Kanavan, disease of Alexander. The most common myelinoclasthies are multiple sclerosis, acute disseminated encephalomyelitis concentric sclerosis (Balo sclerosis), Neuromyelitis optica (Devic disease) diffuse encephalitis of Schilder and subacute leukoencephalitis of Van Bogart .
6. Multiple sclerosis (MS) is a chronic disease of the CNS that begins most commonly in young adults and is characterized pathologically by multiple areas of CNS white matter inflammation, demyelination, and glial scarring (sclerosis) . It usually presents with episodic neurological deficits , which, later on in the course of the disease, tend not to reverse fully, leaving increasingly severe residual deficits whose summation causes progressively severe disability . The clinical manifestations are very diverse because widely separated areas of the CNS are affected and the temporal course of the disease is variable . “Disseminated encephalomyelitis” is a synonym for multiple sclerosis.
7. An important characteristic of MS is that the number of lesions, or plaques, that are discovered scattered throughout the white matte (with occasional extension into gray matter) at autopsy is invariably larger than the number of lesions detected clinically or by means of laboratory tests. These silent lesions may be responsible for aspects of the disease that are poorly understood, especially mental and cognitive disturbances.
8. Epidemiology. MS is particularly common in northern Europe , the northern U.S.A., southern Canada, New Zealand, and southwest Australia. Although environmental factors may be important in etiology, the observation of increased risk of MS in families of an MS patient cannot be lightly dismissed; both environmental and genetic factors are probably important. There are the main of peculiriaties: 1. MS affects women more than men in a ratio of about 1.5 to 1. 2. There are also some clinical differences in different localities. 3. MS is predominantly a disease of young adults.
9. Pathological anatomy. There are disseminated foci of demyelination in the CNS (brain and spinal cord), sometimes with destruction of axons as well. Local, reactive gliosis is found at the sites of older foci. Thus, “sclerosis” develops at “multiple” locations, giving the disease its English name.
10. MRI of the brain and spinal cord in patient with MS
11. MRI of the brain in multiple sclerosis. a Asymmetrically scattered foci of abnormal signal, affecting only the white matter, are seen in the periventricular regions and at the anterior and posterior ends of the lateral ventricles. There is mild internal hydrocephalus. b There are typical signal abnormalities in the corpus callosum, extending into the white matter of the hemispheres.
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13. Pathogenesis. Two major theories about the pathogenesis of MS are being pursued. The first rests on the concept of an infection (presumably by a viral agent) with a long incubation period. The other theory postulates altered immune regulation. The major histocompatibility complex (MHC) on chromosome 6 has been identified as one genetic determinant for MS. The MHS encodes the genes for the histocompatibility antigens (the human leucocyte antigen [HLA] system) involved in antigen presentation to T-cell. The class II haplotype DR15, DQ6, Dw2 is associated with increased risk of MS.
14. Therefore, different infectious agents or other environmental factors may cause or predispose to autoimmune attack upon central myelin. The result of this process is myelin destruction. At the beginning of the process auto-allergic processes prevail over the other ones. Then immunodeficiency is developed. Restoration of a balance between immunosuppressor and cytotoxic cells might induce clinical remission.
16. New data on the ontogeny of human immunity indicate that adult levels of humoral and cellular immunity develop gradually during childhood and may not be mature until the second half of the first decade. In childhood, when there is a natural imbalance of immune components, individuals may be particularly susceptible to a demyelinating type of host response.
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18. Clinical forms I. Cerebral forms: - cortical (epileptic attacks, psychiatric disorders) - visual - brain stem - cerebellar II. Spinal forms: - cervical - thoracic - lumbar-sacral - pseudotabes III. Cerebrospinal
19. The course of the disease: - remittent (exacerbation and remission without progression) - remitting-progressive - secondary progressive (by episodic worsening at first with 2-3 remission, followed by steady progression) - primary progressive ( by steady progression from the beginning ). The periods of the disease: - exacerbation - remission (complete, incomplete) - stable periods
20. Clinical manifestations and neurological findings. The neurological deficits present in each individual patient depend on the number and location of the demyelinating foci. Exacerbations and remissions occur frequently. The main characteristics of the symptoms of MS are : - multiplicity - the tendency to vary in nature - severity with the passage of time - complete remission of the first symptoms occurs frequently but, with subsequent attacks, remissions do not occur or are incomplete. - the clinical course extends for one or many decades in most cases, but a few may terminate in death within a few months of onset.
21. The following are among the more characteristic disease manifestations and physical findings: - retrobulbar neuritis - disturbances of ocular motility - Lhermitte sign - p yramidal tract signs - cerebellar signs - gait impairement - sensory deficits - bladder dysfunction - ictal phenomena - mental disturbances
22. Retrobulbar neuritis is usually unilateral. Over the course of a few days, the patient develops an impairment of color vision , followed by a marked impairment of visual acuity (finger counting is barely possible). Orbital pain is often present and the patient may see flashes of light on movement of the globe . These problems begin to improve in one or two weeks and usually resolve completely. The temporal side of the optic disc becomes pale three or four weeks after the onset of symptoms. Retrobulbar neuritis rarely affects both eyes, either at the same time or in rapid succession. Recurrences are rare.
23. If retrobulbar neuritis is an isolated event in a patient otherwise free of neurological disease, the probability that other clinical signs of multiple sclerosis will appear in the future is roughly 50%. This probability is greater if pathological changes are seen in the CSF or on an MRI scan. Temporal papillary atrophy (after optic neuritis)
24. Disturbances of ocular motility. Diplopia , particularly due to abducens palsy , is a common early symptom but nearly always resolves spontaneously. Later, typical findings are nystagmus (often dissociated) and internuclear ophthalmoplegia , often without any subjective correlate. Internuclear ophthalmoplegia in a young patient is relatively specific for multiple sclerosis. This condition is caused by a lesion of the medial longitudinal fasciculus (MLF). When the patient attempts to look away from the side of the lesion, the ipsilateral (adducting) eye cannot fully adduct, and the contralateral (abducting) eye exhibits end-gaze nystagmus.
25. The inability of the ipsilateral eye to adduct is not due to a lesion of the oculomotor n. nucleus, as is demonstrated by a preserved ability to adduct (converge) in the near reflex. Internuclear ophthalmoplegia (INO) can also be bilateral if the MLF is damaged on both sides. Right internuclear ophthalmoplegia in a patient with multiple sclerosis. In the initial phase of leftward gaze (upper photograph), only the left eye is abducted. The right eye follows, after a delay (lower photograph).
26. Test for visual field defects (confrontation test) Central scotoma
27. Lhermitte sign (positive neck-flexion sign). Active or passive forward flexion of the neck induces an “electric” paresthesia running down the spine and/or into the limbs. Retrobulbar neuritis, disturbances of ocular motility, sensory deficits, and Lhermitte sign are common early findings in multiple sclerosis. Pyramidal tract signs and exaggerated intrinsic muscle reflexes may be present early in the course of the disease. The abdominal cutaneous reflexes are absent . Later on, in almost all patients, spastic paraparesis or quadriparesis develops.
29. Cerebellar signs are practically always present in advanced MS, incl u ding impaired coordination , ataxia , and, frequently, a very characteristic intention tremor Gait impairment often becomes severe early in the course of the disease. Typically, the combination of spastic paraparesis and ataxia results in a spastic−ataxic, uneven, uncoordinated, and stiff gait .
30. Sensory deficits are found early in the course of the disease in about half of all patients. Vibration sense in the lower limbs is nearly always impaired. Pain is not uncommon; sometimes there is even a dissociated sensory deficit. Bladder dysfunction is present in about three-quarters of all patients (generally in association with spasticity); disturbances of defecation are much rarer. Bladder dysfunction is sometimes an early manifestation of the disease.
31. Urge incontinence is highly characteristic, i. e., a sudden, almost uncontrollable need to urinate, perhaps leading to “accidents” and bedwetting. Patients often do not mention bladder dysfunction until they are directly asked about it.
32. Ictal phenomena of various types are not uncommon. About 1.5% of persons with MS suffer from trigeminal neuralgia , which may alternate from one side to the other. Acute dizzy spells can occur, as can paroxysmal dystonia , dysarthria , or ataxia. The characteristic so - called tonic brainstem seizures consist of paroxysmal, often painful, tonic stiffness of the muscles on one side of the body. The lower limb is hyperextended, the upper limb flexed (Wernicke−Mann posture).
33. Mental disturbances are not severe early in the course of the disease. Later on, however, ma - ny patients develop psychoor - ganic changes and psycho - re - active and depressive distur - bances. Psychosis is very rare.
39. MS degree: I – patient has difficulty to walk only after physical training II – patient has difficulty to walk and weakness on 2-3 km III – patient has spastic-paretic gait, difficulty to walk and weakness on 200-300m IV – patient can not to walk without help V – patient can not to walk or has blindness
42. Evoked potentials. Visual evoked potential (VEP) studies reliably detect optic nerve lesions, VEP reveals prolongation of the P100 latency in one eye and/or an abnormally large discrepancy between the latencies in the two eyes in roughly 40% of MS patients without known optic neuritis, and in almost half of those with early optic neuritis. Somatosensory evoked potential (SEP) studies of the median or tibial nerve typically reveal prolonged latencies in MS. Low amplitude of evoked potentials, on the other hand, often indicates a pathological process of another type, e. g. tumor. SEP abnormalities are found in up to 60% of MS patients with predominantly sensory manifestations.
43. Auditory evoked potential (AEP) studies are less sensitive in MS than VEP or SEP. The most common AEP change is prolongation of latency. AEP studies are helpful for the further classification of vertigo, tinnitus, and hearing loss. Motor evoked potential (MEP) studies reveal prolonged central conduction times when CNS lesions involve the pyramidal pathway. The sensitivity of MEP in MS is approximately the same as that of SEP. MEP studies can provide supporting evidence for MS in patients with latent paresis, gait disturbances, abnormal reflexes, or movement disorders that are difficult to classify.
44. Tests of bladder function. The residual urine volume can be measured by ultrasound. It should not exceed 100 ml in patients with a normal bladder capacity of 400–450 ml; in general, it should normally be 15–20% of the cystomanometrically determined bladder volume. Urodynamic electromyography (EMG) provides more specific data concerning bladder dysfunction.
45. CSF examination. CSF abnormalities are found in more than 95% of MS patients. The cell count rarely exceeds 20 cells/mm3. The total protein concentration is elevated in ca. 40% of patients, and intrathecal IgG synthesis (IgG index) in ca. 90%. Oligoclonal IgG is found in 95% of MS pati - ents, and antibodies to mumps, measles and herpes zoster in 80%. Oligoclonal bands in the serum (a) and CSF (b) of a patient with multiple sclerosis ; compare with the serum ( c ) and CSF ( d ) of a normal control subject.
46. Differential Diagnosis There is no single clinical test, imaging study, or laboratory finding that alone establishes the diagnosis of MS. A meticulous differential diagnostic evaluation is needed in every case. (Cerebral) Vasculitis. Systemic lupus erythematosus, Sjögren syndrome, Behçet syndrome, granulomatous angiitis, polyarteritis nodosa, antiphospholipid syndrome, chronic inflammatory demyelinating polyradiculoneuro - pathy.
48. Tumors of the brain or spinal cord ( lymphoma, glioma,meningioma). Skull base anomalies . Arnold–Chiari malformation, platybasia. Myelopathy . Cervical myelopathy (spinal stenosis). Somatoform disturbances in the context of mental illness. Prognosis Favorable prognostic indicators in MS include onset b e- fore age 40, monosymptomatic onset, absence of cere - bellar involvement at onset, rapid resolution of the initial symptom(s), a relapsing-remitting course, short duration of relapses, and long-term preservation of the ability to walk.
49. A relatively favorable course is also predicted if, after the first 5 years of illness, the MRI reveals no more than a few, small lesions without rapid radiological progression and the clinical manifestations of cerebellar disease and central paresis are no more than mild. A benign course , defined as a low frequency of recurrences and only mild disability in the first 15 years of illness, is seen in 20–30% of patients. The disease takes a malignant course , with major disability within 5 years, in fewer than 5% of patients. Half of all MS patients have a second relapse within 2 years of disease onset.
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53. Symptomatic therapy/rehabilitation. Medications, physical, occupational, and speech therapy, social, psychological, and dietary counseling, and mechanical aids (e. g., walking aids, wheelchair) are provided as needed. The possible benefits of oligodendrocyte precursor cell transplantation for remyelination, and of growth factors and immunoglobulins for the promotion of endogenous remyelination, are currently under investigation in both experimental and clinical studies.
54. Gait problems are the most common disability of MS; the problems respond to treatment if spasticity is the major cause. In these cases, careful use of baclofen is helpful, but if too much is administered, spasticity gives way to excessive flaccidity and makes the gait disorder worse. Intention tremor occasionally responds to propranolol 320 mg per day in divided dosage. Cryothalamotomy has been used, but the complication of pseudobulbar palsy makes this too hazardous.
55. Diffuse encephalitis of Schilder. The diagnostic criteria established by Poser in 1985 require 6 elements: 1. One or 2 roughly symmetrical large plaques are manifest, and if more than 1 is present, 1 should be in each brain hemisphere, chiefly in the centrum semiovale. 2. No other lesions are demonstrable by clinical, paraclinical, or imaging data. 3. No abnormalities of the peripheral nervous system are demonstrable. 4. Results of adrenal function studies are normal. 5. Serum very long chain fatty acids are normal. 6. Pathological analysis by autopsy or biopsy demonstrates histologic changes consistent with subacute or chronic myelinoclastic diffuse sclerosis, changes which in essence cannot be distinguished from those of multiple sclerosis.
56. No features of the general examination are characteristic features of the presentation of Schilder disease. Aphasia , memory disturbances , mental dullness , irritability , changes in personality , confusion, disorientation , and behavioral disturbances are not infrequently encountered. Patients may appear to be psychotic . Deafness is common. Other brainstem or cerebellar deficits that are encountered include vertigo ; paresis of eye movements , including internuclear ophthalmoplegia and nystagmus ; facial palsy ; dysarthria ; or dysphagia .
57. Peripheral cranial nerve abnormalities that are sometimes encountered include optic neuritis and optic atrophy. Cortical blindness is common, and various field cuts may be found, particularly hemianopsia. Hemiparesis or cortical sensory deficits may be found. Seizures may occur but are not common. Some patients manifest psychosis. Extrapyramidal manifestations are rare but have been described. Findings of variable or uncertain localization include generalized spasticity and incontinence of bowel and bladder function. Malnutrition and cachexia are commonly reported in the middle or late chronic stages of illness, especially in instances where patients fall to a low level of neurologic function such as a chronic vegetative state.