Welcome back to neuropathology.
Here, we’ll take a look at
We’ll walk through the
most common conditions,
and then as we journey
through this further,
we’ll get into more
It’s important that you pay
attention to the definitions
and pay attention to what
is the underlying cause of
the particular demyelinating disease.
We’ll begin our discussion by
looking at multiple sclerosis.
And when you say multiple
you should be thinking that
this one of the most common
demyelinating diseases that
you shall see in the U.S.
The second thing that you want to do
is pay attention to the definition.
the two major components in this
paragraph that are important to you
is the separation into time
and the separation in space.
The next question you want to ask yourself
is, what is being separated in time?
And that would actually be
the neurologic defects.
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.
The operative words here: time and space,
time referring to
and the space referring to the
degeneration of the white matter.
The clinical course is here.
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.
And by this, we mean that there’s
going to be a relapsing and remitting
type being the most
The X axis, the horizontal line,
represents the time course;
meaning to say, in general,
the age of the patient.
The Y axis represents the
or the severity of the disease.
So, the higher you go, the
more severe is the disease.
Now, you’ll notice, please,
that the top graph represents
a most common pattern,
which is the relapsing and remitting
progression of multiple sclerosis.
The relapsing-remitting pattern is
encountered in approximately 85%
of patients with multiple sclerosis.
It is characterized by unpredictable exacerbations
of the disease followed by periods of remission.
The patient usually recovers completely
or almost completely from the attacks.
Approximately half of these patients progress
to the secondary progressive pattern of the disease
as you can see on the second graph.
This pattern is characterized by progressive
deterioration without periods of remission
after an initial relapsing-remitting course of the disease.
Primary progressive multiple sclerosis,
as you can see on the third graph,
is characterized by progressive neurologic deterioration
from the onset of disease.
The rarest pattern is the progressive-relapsing pattern
of multiple sclerosis which is depicted in the fourth graph.
As you can see on the slide the patient is experiencing
a progressive deterioration superimposed with attacks.