MULTIPLE SCLEROSIS (MS)

AN IDIOPATHIC AUTOIMMUNE Dz AGAINST MYELIN

FEMALE 3:2, MIDDLE AGED

TEMPERATE CLIMATE (LATITUDINAL BAND OF INCIDENCE)

20% BENIGN COARSE

70% INTERMEDIATE

10% SEVERELY DEBILITATING

CHARCOT’S TRIAD

: NYSTAGMUS, SCANNING SPEECH, INTENTION TREMOR

10% OF ADULTS AND 20% OF CHILDREN PRESENT WITH AUDIOVESTIBULAR SYMPTOMS

UNILAT TINNITUS, UNILAT HIGH FREQ. SNHL, ABNL ABR(CONDUCTION DELAY)

VERTIGO (50% OF PTS WILL EVENTUALLY DEV. VERTIGO)

CENTRAL (SPONT. OR VERTICLE, PRESENT WITH VISUAL FIXATION) NYSTAGMUS—CAN GET POSITIONAL NYSTAGMUS

ATAXIA, OSCILLOPSIA

CAN LOOK ERRONOUSLY LIKE MENIER’S

DYSCONGUGATE GAZE OFINTERNUCLEAR OPHTHALMOPLEGIA(MLF DEMYELINATION)=PATHOGNEUMONIC

OPTIC NEURITIS—VISUAL BLURRING—SCOTOMA

OPTIC ATROPHY—AFFERENT PUPILLARY DEFECT–MARCUS GUNNPUPIL

ABNL COLOR VISION

25% OF PTS WITH MS HAVETRIGEMINAL NEURALGIA(TIC DOULOUREUX, HUNT’S NEURALGIA, PROSOPALGIA), 3% OF PTS WITH TN HAVE MS (HIGHER IN YOUNG PTS WITH TN)

CLUMMSINESS, ATAXIA, DYSARTHRIA, IMPOTENCE, PARESTHESIAS

DO NOT USE AMINOGLYCOSIDES—POTENTIATES OTO AND NMJ TOXIC EFFECTS

Dx: MRI–PLAQUES OF DEMYELINATION AROUND THE 4TH VENTRICLE

CSF–HIGH IgG (MYELIN BASIC PROTEIN)

ABR (CONDUCTION DELAY)

Rx: STEROIDS, ACTH, AUTOIMMUNE DRUGS, BETA-IFN