MRI of brain and spinal cord

Visual evoked potential

CSF examination (lymphocytes/oligoclonal bands) (3)

You’ve (hopefully) mentioned MRI. What are the advantages and disadvantages of using MRI?

Adv:
-gold standard
-excellent soft tissue differentiation
-images in any plane

Disadv:
-not as readily available and more expensive than CT
-CT better for bone
-pacemakers contraindicated (3)

What condition do you suspect?

Multiple sclerosis (1)

Name the key requirement for diagnosis of MS?

Evidence of damage to CNS/lesions separated by time and space (2)

Name 4 other symptoms of MS?

Optic neuritis- pain, impaired colour vision

Diplopia

Spastic paraparesis

Fatigue

Bladder disturbance

Erectile dysfunction

Cerebellar dysarthria

Mood disturbance (3)

What are three types of MS? 

Remitting/relapsing

Primary progressive

Secondary progressive

Benign MS (2)

Name two ways to treat MS

Corticosteroids – used to reduce time to recovery following relapses but do not affect degree of recovery

B interferon – reduces immune response –  benefits some patients

Copaxone- induces Th2 cells that migrate to brain and downregulate activation of pathogenic Th1 cells

Natalizumab/other appropriate monoclonal antibody  – monoclonal ab to integrin molecules on t cells preventing them from crossing blood brain barrier (3)

The definite pathophysiology behind MS is not fully understood yet. There is circumstantial evidence that MS could be an autoimmune attack mediated by inflammatory cells such as T cells and macrophages.

What cells are the first line of defence in the CNS?

Microglia (1)

What are the three functional states that microglia can switch between? 

Surveillance

Activated

Phagocytic (2)