AIDS (acquired immune deficiency syndrome) Low CD4 T cell count 200, Opportunistic infections HIV/AIDS Key Features CNS Signs Confusion Dementia Fever Visual changes Memory loss Personalitychanges Pain Seizures CNS Inflammation causes damage to the

Multiple Sclerosis Incidence/Prevalence • Gender: affects more women than men • Age: highest incidence 20-40 yrs. Known as disease of the young • Incidence: about 500,000 people in the US are currently affected. Incidence in the first degree relatives of a person with MS is 15%. Life expectancy is about 85% of normal persons (or about 35 years after onset of symptoms) • Geographics: seen more in colder climates (north eastern, Great Lakes and Pacific north-western states as weel as Canada) Multiple Sclerosis Causes • Unknown but theories include • Viruses • Immunologic factors • Genetics • Environmental Factors Previous Pause Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:54 Full screen 6 Ways to Show Appreciation for Your Child's Teacher Multiple Sclerosis Pathophysiology • In MS demyelination is scattered irregularly throughout the CNS. The plaques (patches in involved areas) become sclerosed, interrupting the flow of nerve impulses and result in a variety of manifestations depending on which nerves are affected • The area most frequently affected are the optic nerves, pyramidal tracts, the cerebrum, then brain stem, cerebellum and spinal cord Multiple Sclerosis Remission and Exacerbations • Exacerbations: new symptoms appear and existing ones worsen. • Remissions: symptoms decrease or disappear • Relapses: may be associated with periods of emotional and physical stress. With repeated exacerbations of the disease, damage to the axons become permanent • Plaques: do not produce serious symptoms and patients are not seriously incapacitated but have long periods of remission between episodes Multiple Sclerosis Types • Relapsing-Remitting MS (RRMS): 80-85% of cases with complete recovery between symptomatic exacerbations. - Does not progress between lapses. - Course of disease mild or moderate depending on severity of disabilities. - Relapses develop over 1-2 weeks and resolve over 4-8 months. Some may progress to SPMS • Secondary Progressive MS (SPMS): begins with RRMS that later becomes more progressive. Attacks and partial recoveries may continue to occur Multiple Sclerosis Types • Progressive-Relapsing MS (PRMS): 5% of patients. - Absence of periods of remission and the patients condition does not return to baseline. - Progressive, cumulative symptoms and deterioration occur over several years • Primary-Progressive MS (PPMS): 10-20% of patients. - Steady and gradual neurologic deterioration without remission of symptoms. - The patient has progressive disability with no acute attacks. - 40-60 years of age at onset of the disease Multiple Sclerosis - Manifestations Respiratory: • diminished cough reflex, respiratory complications (pneumonia, etc) Musculoskeletal/Motor: - stiffness of extremities especially legs. (OFTEN reported by patient) - fatigue: very common, 70-90% - limb weakness (or "heaviness") - ataxia (clumsy, shaky, uncoordinated) - spasticity of extremities: flexor spasms may awaken patient - increased reflexes: DTR, clonus, positive Babinski - Intention tremor: (tremor when performing activity) - dysmetria - loss of abdominal reflex - muscle atrophy - talipes equinus: foot drop - dysarthria with slurred speech: (CN III & XII. patient seems to search for words) Multiple Sclerosis - Manifestations Sensory: visual disturbances due to lesions on the optic nerve - blurring or cloudy vision - diplopia, eye pain, vertigo - nystagmus, numbness - visual field deficits: patchy blindness, blind spots etc due to optic neuritis - tactile sensory deficits: hands and feet - paresthesias - diminished sense of temperature - pain with spasms - loss of proprioception Multiple Sclerosis - Manifestations Neurological • Uhthoff's Sign (Lemone) - sudden worsening of motor symptoms after hot shower/bath • Lhermitt's Sign: bilateral shock-like sensation felt down body when patient's neck is flexed • Depression, emotional lability (euphoria, irritability) • Memory deficits, Personality changes • Impaired judgement, convulsive seizures • Dementia is rare Multiple Sclerosis - Manifestations Gastrointestinal • Nausea • Difficulty chewing, Dysphagia • Bowel incontinence, constipation Sexual Dysfunction • Males: impotence • Females: loss of genital sensation Secondary Complications • UTIs, Pressure ulcers, Contractures, Dependent pedal edema • Pnemonia, Reactive depression Multiple Sclerosis - Manifestations Urinary • Bladder problems include: - Hyperreflexic: inability to store urine - Hypotonic: inability to empty bladder - a mixture of both • Hestiancy, Frequency • Retention, Reflex bladder emptying • Reccuring UTIs • Incontinence Multiple Sclerosis Course of the Disease • Sometimes not diagnosed until autopsy • Course is individualized and difficult to predict due to unpredictable nature • Most people live relatively normal lifespan • COD is usually related to infectious process such as UTI or pneumonia. • In rare instances, acute onset with sudden progression of neurologic symptoms, headache, convulsions, coma and death within 1-2 years Multiple Sclerosis Diagnostic Test • No definitive diagnostic procedure, diagnosis is made by exclusion of other neuro diseases • *MRI: primary tool. Visualizes plaques and evaluates course of disease • Lab Studies: - CSF: high protein and increase in WBC - CSF Electrophoresis: increase in myelin basic protein and presence of oligoclonal (IgG) bands seen in 95% of patients with MS Multiple Sclerosis Diagnostic Test • Evoked Response Test: defines extent of disease process and monitors changes. - testing visual,auditory or somato sensory impulses show sensitivity to delayed conduction • Neurodynamic Studies: detect bladder dysfunction