Multiple Sclerosis: Introduction

by Carlo Raj, MD

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    00:01 Welcome back to neuropathology.

    00:03 Here, we’ll take a look at demyelinating diseases.

    00:06 We’ll walk through the most common conditions, and then as we journey through this further, we’ll get into more detail-oriented diseases.

    00:13 It’s important that you pay attention to the definitions and pay attention to what is the underlying cause of the particular demyelinating disease.

    00:21 We’ll begin our discussion by looking at multiple sclerosis.

    00:25 And when you say multiple sclerosis, automatically, you should be thinking that this one of the most common demyelinating diseases that you shall see in the U.S.

    00:33 The second thing that you want to do is pay attention to the definition.

    00:37 And here, the two major components in this paragraph that are important to you is the separation into time and the separation in space.

    00:47 The next question you want to ask yourself is, what is being separated in time? And that would actually be the neurologic defects.

    00:55 So anytime that the patient is suffering from, let’s say a relapsing course or a neurologic defect, how much time is there in between in terms of intervals? And then secondly, what does space referring to? It’s referring to the actual demyelination, or in other words, the physical pathologic destruction that’s taking place of the white matter, and that would be separated by space.

    01:21 The operative words here: time and space, time referring to neurologic deficit, and the space referring to the degeneration of the white matter.

    01:31 The clinical course is here.

    01:33 Now, one that’s the most common in terms of clinical course will be, and I’ll walk you through this quickly, but the one that I’ll spend a little bit more time with will be the top graph that you see, the top graph.

    01:44 And by this, we mean that there’s going to be a relapsing and remitting type being the most common pattern.

    01:50 The X axis, the horizontal line, represents the time course; meaning to say, in general, the age of the patient.

    02:00 The Y axis represents the progressive deterioration or the severity of the disease.

    02:07 So, the higher you go, the more severe is the disease.

    02:10 Now, you’ll notice, please, that the top graph represents a most common pattern, which is the relapsing and remitting progression of multiple sclerosis.

    02:24 So you’ll notice that you’ll have a spike ever so often but you’ll have a steady increase in severity of the disease itself.

    02:32 So over the age of the individual, as the person is getting older, they would have time in which they are going to remission, which is then still a steady progression, but still, every time that they’re having relapse, it seems as though that the disease is a little bit worse.

    02:48 So maybe initially, there might be a little bit of blurring and and what we call optic neuritis and visual disturbance, and then it goes away for a little bit.

    02:56 Then it comes back.

    02:57 When it comes back, now there might be issues with some kind of neuropathy elsewhere, and then it goes back into remission, and so on and so forth.

    03:05 An overall theme for all the graphs here are exactly that.

    03:09 Age on the X axis and then you have the severity of the disease on the Y axis.

    03:13 The most common pattern is going to be the top first one in which we see a steady, steady progression and deterioration of your nervous system.

    03:24 Now, we have secondary progressive, may have superimposed relapses.

    03:28 And so therefore, if you take a look at this with secondary, which is the second graph from the top, we have what’s known as your secondary progressive or secondary type of relapsing.

    03:39 You’ll notice here that in terms of progression, that it’s not a steady deterioration over the course of time or age.

    03:49 But you’ll notice that there is, let’s say relapsing and remission type of a condition or behavior, and then all of a sudden, take a look at the very, very right end of this graph.

    04:02 You’ll notice that there’s, all of a sudden, a steady progression abruptly and spontaneously.

    04:07 This is the very characteristic of secondary progressive.

    04:13 And then you have primary progressive.

    04:15 And this, just to be quick here, will be the third graph from the top, and you’ll notice that you do not have such a remitting and relapsing type of course, that you have just a primary progressive.

    04:28 These are the ones that are less common in terms of clinical presentation to you.

    04:33 And the one that you will pay attention to most in this section of clinical course will be the first bullet point, which correlates with the first top graph.

    04:43 Once you’ve understood that and you take a look at the bottom two graphs, then you had the third one in which, here once again, it’s unpredictable progression of deterioration.

    04:52 So, there might be remitting, relapsing, and so on and so forth, but honestly, it’s absolutely unpredictable.

    04:57 That is all that I wish to say about the bottom most graph in this discussion.

    About the Lecture

    The lecture Multiple Sclerosis: Introduction by Carlo Raj, MD is from the course Multiple Sclerosis.

    Included Quiz Questions

    1. Steady restoration of motor function.
    2. Slow loss of motor function.
    3. Rapid loss of motor function.
    4. Relapsing and remitting loss of motor function.
    5. Unpredictable loss of motor function.
    1. Multiple sclerosis
    2. Pick disease
    3. Alzheimers disease
    4. Crutzfield Jacob disease
    5. Progressive multifocal encephalopathy

    Author of lecture Multiple Sclerosis: Introduction

     Carlo Raj, MD

    Carlo Raj, MD

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