DEMYELINATING DISEASES [j-04]
MULTIPLE SCLEROSIS-
- Autoimmune dis
- Relapsing-remitting
- Adolescence-mid age
- 2F=M
PATHOLOGY-
- Focal inflamn
- Demyelination & gliosis or scarring
- Lesions are disseminated thru out the brain,so also k/as Disseminated sclerosis
- Selective demyelination with relative sparing of axons-hallmark
- PLAQUES- multiple grayish,sclerotic lesions scattered in the white matter-periventricular
- Medullary sheaths of the nerve fibres are specially attacked,axons being spared
C/F- OCULAR
- Retrobulbar neuritis-Hemianopic & quadrantic field changes
- OA
- Retinal venous sheathing
- Nystagmus [very imp sign]-horizontal,ataxic &increases on extreme lat gaze
- RAPD
- EO ms paralysis
- INO
- VI n Palsy
SYSTEMIC-
- Limb weakness
- Sensory loss
- Paraesthesia
- Vertigo
- Ataxia
- Lhermitte sign-A transient electric shock like sensation shooting down the spine into the legs induced by neck flexion
- CHARCOT’S TRIAD-SIN
- slurred speech
- intention tremors
- nystagmus
INV-M 3V 4AE
- MRI- head & spine-periventricular plaques
- CT-scan-perivascular & deep white matter lesions
- Serum vit B12 levels
- VDRL
- ESR
- Antinuclear antibody
- Anti-DNA antibodies
- Angiotensin converting enzyme
- VEP
- Automated perimetry
T/T-PIIP
- Pulse IV methylprednisolone
- Interferon –B1a or IFN-B1b
- IV immunoglobins
- Physiotherapy
NEUROMYELITIS OPTICA [DEVIC’S DISEASE ] [J-03]
- variant of MS-acute & violent form
- BL optic neuritis + Transverse myelitis
- Lumbar /dorsal myelitis
ACUTE DISSEMINATED ENCEPHALOMYELITIS [ADEM]
Young adults
- Fever,headache,drowsiness & convulsions
- EYE- Retrobulbar neuritis
-Papillitis
-OA
DIFFUSE PERIAXIAL ENCEPHALITIS [SCHILDER’S DIS]
- infancy & childhood
- Massive demyelination in the cerebral & cerebellar hemisphere f/b gliosis
- Systemic –deafness,psychosis,aphasia,UMN palsy,ataxia
- OCULAR-OccIpital lobe lesion-LOV
-Brainstem lesion-nystagmus,ocular palsies & papillary def
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