神经病学精品教学：MULTIPLE SCLEROSIS.pptVIP

MULTIPLE SCLEROSIS(MS);Definition;One of the most important diseases by virtue of its frequency, chronicity, and tendency to attack young adults. The neurologic manifestations are determined by the varied location and extent of the demyelinative foci. ;Etiology Epidemiology;Heritability The incidence of MS in first degree relatives is 20 times higher than in general population 20% of index cases had an affected relative, again with the highest risk in siblings. The diagnosis was verified in 12 of 35 pairs of monozygotic twins (34 percent) and in only 2 of 49 pairs of dizygotic twins (4 percent) Certain histocompatibility antigens (HLAs) are more frequent in patients with multiple sclerosis than in control subjects. ;Epidemiology: The incidence of MS is two or three times higher in women than in men About 2/3 of cases of MS have their onset between 20 and 40 years of age ;Possible Mechanism : A relationship between MS and some environmental factor (viral or other infection) that is encountered in childhood and, after years of latency, either evokes the disease or contributes to its causation-Initial Mechanism Secondary mechanism is an autoimmune reaction, attacking some components of myelin and, in its most intense form, destroying all tissue elements, including axons. ;Possible Mechanisms of Demyelination in CNS - Immune Cell Activation;Possible Mechanisms of Demyelination - Phagocytosis Apoptosis;Clinical Manifestations;Optic Neuritis ;Acute Myelitis (Transverse Myelitis);Other Patterns of Multiple Sclerosis ;Lhermitte sign: Passive flexion of the neck may induce a tingling, electric-like feeling down the shoulders and back or down the anterior thighs Tic douloureux ;Laboratory Findings;Cerebrospinal Fluid :;MRI ;Evoked Potentials and Other Tests ;Diagnosis;Benign Multiple Sclerosis Mild infrequent sensory exacerbations with full recovery.;Differential Diagnosis;Differential Diagnosis;Differential Diagnosis;Corticosteroid-responsive cerebral lym