By Rahul Jandial, Evan Y. Snyder Eugene C. Toy
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Extra info for Case Files: Neuroscience (Case Files)
He presents to your office in Minneapolis, MN, this time with double vision when he attempts to look to either his left or right side. Following several further tests, you diagnose him presumptively based on the multiple attacks and remissions of weakness and eye problems as having multiple sclerosis (MS), which is a disease of the white matter of the central nervous system. ◆ ◆ ◆ Describe the characteristics of white matter of the brain. What is the mechanism of the weakness caused by white matter degeneration?
This lesion prevents the oculomotor nuclei and the abducens nuclei from coordinating their movements through the MLF. With lateral gaze, the contralateral medial rectus fails to adduct the eye, while the ipsilateral lateral rectus abducts the eye. The dyscoordinated movements of the eye result in diplopia. MRI scans are the preferred imaging modality CLINICAL CASES 33 for diagnosis of this disease. Approximately 80% of individuals with a clinical diagnosis of MS will exhibit white matter abnormalities on MRI scans.
Mechanism of weakness: MS causes the gradual deterioration of the protective myelin sheaths around axons (demyelination) that facilitate signal conduction. Without myelin, the neurons cease to effectively conduct their electrical signals, resulting in a myriad of clinical symptoms (some presented above). MS is categorized as an autoimmune disease where lymphocytes attack the myelin surrounding axons as if it were a foreign agent. Treatment options: Beta interferon can help to reduce the number of exacerbations.