CT Scan Multiple Sclerosis Lesions

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Questions and Answers

What is the characteristic of demyelinating diseases of the CNS?

Complete loss of both myelin and axons

Preferential damage to axons with relative preservation of myelin

Inflammation of the meninges

Preferential damage to myelin with relative preservation of axons (correct)

Which of the following is NOT a cause of demyelination?

Aging (correct)

Inherited disorders

Immune mediated

Viral infection

What is the prevalence of multiple sclerosis in the United States and Europe?

1 per 5000 persons

1 per 500 persons

1 per 1000 persons (correct)

1 per 10000 persons

What is the characteristic of multiple sclerosis?

Distinct episodes of neurologic deficits, separated in time and space Signup and view all the answers

What is the target of the autoimmune response in multiple sclerosis?

Oligodendrocytes Signup and view all the answers

What is the sex ratio of multiple sclerosis?

Women are affected twice as often as are men Signup and view all the answers

What is the primary target of the autoimmune response in Multiple Sclerosis?

Myelin sheath Signup and view all the answers

What is the role of genetic factors in the pathogenesis of Multiple Sclerosis?

They have a strong effect, particularly with the DR2 extended haplotype Signup and view all the answers

What is the expected outcome of the disease over time?

A steady neurologic deterioration in most affected individuals Signup and view all the answers

What is the role of environmental factors in the pathogenesis of Multiple Sclerosis?

They interact with genetic factors to contribute to the disease Signup and view all the answers

What is the consequence of the loss of control of skeletal muscles in Multiple Sclerosis?

No breathing Signup and view all the answers

What is the association of the IL-2 and IL-7 receptor genes with Multiple Sclerosis?

They are associated with the development of the disease Signup and view all the answers

What is the result of the activation of TH1 and TH17 cells in the context of autoimmune disease?

Demyelination of the myelin sheath Signup and view all the answers

What is the characteristic of the plaques found in the brain of a patient with MS?

Firmer than the surrounding white matter and well-circumscribed Signup and view all the answers

What is the role of genetic factors in the development of autoimmune disease?

Genetic factors predispose individuals to develop autoimmune disease Signup and view all the answers

What is the result of the demyelination of the myelin sheath?

Neurologic deterioration and loss of function Signup and view all the answers

What is the role of IFN-γ in the autoimmune response?

It activates macrophages and leads to demyelination Signup and view all the answers

What is the characteristic of the macrophages found in active plaques?

They contain lipid-rich, PAS-positive debris Signup and view all the answers

Study Notes

Multiple Sclerosis (MS)

MS is an autoimmune demyelinating disorder characterized by distinct episodes of neurologic deficits, separated in time, attributable to white matter lesions that are separated in space.
The disease may become clinically apparent at any age, although onset in childhood or after age 50 years is relatively rare.
The frequency of relapses tends to decrease during the course of time, but there is a steady neurologic deterioration in most affected individuals.
MS will continue to progress with relapses, usually leading to death due to respiratory failure (lung collapse).

Pathogenesis

The lesions of MS are caused by an autoimmune response directed against components of the myelin sheath.
The pathogenesis of this disease involves both genetic and environmental factors.
There is a strong effect from the DR2 extended haplotype of the major histocompatibility complex.
Genome-wide association studies first identified additional associations with the IL-2 and IL-7 receptor genes.

Demyelinating Diseases

Demyelinating diseases of the CNS are acquired conditions characterized by preferential damage to myelin with relative preservation of axons.
Myelin loss will affect the transmission of electrical impulses along axons.
Several pathologic processes can cause loss of myelin, including immune-mediated, viral infections, and inherited disorders.

Characteristics of MS

MS is the most common of the demyelinating disorders, having a prevalence of approximately 1 per 1000 persons in most of the United States and Europe.
Women are affected twice as often as are men.
MS affects oligodendrocytes.
The infiltrate in plaques and surrounding regions of the brain consists of T cells (mainly CD4+, some CD8+) and macrophages.

Pathological Features

Macroscopically, lesions are firmer than the surrounding white matter (sclerosis) and are well circumscribed, somewhat depressed, glassy, gray-tan, irregularly shaped plaques.
Microscopically, active plaques have abundant macrophages containing lipid-rich, PAS-positive debris, while inactive plaques have little to no myelin found.
Plaques commonly occur adjacent to the lateral ventricles, and are also frequent in the optic nerves and chiasm, frequently brainstem, ascending and descending fiber tracts, cerebellum, and spinal cord.

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Description

This quiz covers the characteristics of Multiple Sclerosis lesions in CT scans, including their typical location, age of onset, and disease progression. Test your knowledge of this important medical topic!