MS is predominantly a white a matter disease and a
neurodegenerative disorder of the central nervous
system that includes the brain, spinal cord and nerves
It is an inflammatory and demyelinating disease.
Inflammation: body’s own immune cells attack the
Demyelination: myelin (protective covering of the
nerves) is destroyed leaving multiple areas of scar
tissue or sclerosis.
It is progressive disease
Most common age of occurrence – between 20 and 40
MS is particularly common in northern Europe , the
northern U.S.A., southern Canada, New Zealand, and
Worldwide occurrence:1.1 – 2.5 million cases.
Its not contagious.
There are the main of peculiarities:
1. MS affects women more than men in a ratio
of about 1.5 to 1.
2. There are also some clinical differences in
3. MS is predominantly a disease of young
There are some of the causes :
1) Genetic susceptibility
2)Infections (rubella, mumps, corona virus, parainfluenza,
herpes simplex, Epstein-Barr, human T-cell lymphotropic
virus type I viruses)
3) Dysbalance of steroid hormones (estrogenic)
4)Geographical (ground, water properties) other (toxic,
Retro bulbar neuritis
Retro bulbar neuritis is usually
Impairment of color vision
Impairment of visual acuity
(finger counting is barely possible).
Orbital pain is often present
Able to see flashes of light on
movement of globe
The temporal side of the optic
disc becomes pale three or four weeks.
Retro bulbar neuritis rarely
affects both eyes, either at the same
Disturbance in ocular motility
Diplopia particularly due to abducens palsy
, is a common early symptom.
Internuclear ophthalmoplegia in a young
patient is relatively specific for multiple
sclerosis. This condition is caused by a
lesion of the medial longitudinal fasciculus
Right Internuclear ophthalmoplegia in a
patient with multiple sclerosis. In the
initial phase of leftward gaze (upper
photograph), only the left eye is abducted.
The right eye follows, after a delay (lower
Pyramidal tract signs
Pyramidal tract signs and exaggerated intrinsic muscle
reflexes may be present early in the course of the
Abdominal cutaneous reflexes are absent.
Spastic paraparesis or quadriparesis develops.
(central paresis, spasticity, abnormal fatigability)
Present in advanced MS
impaired coordination , ataxia ,
and frequently a very characteristic
severe early in the course of
spastic paraparesis and
ataxia results in a spastic−ataxic,
uneven, uncoordinated, and
stiff gait .
I – patient has difficulty to walk only after physical
II – patient has difficulty to walk and weakness on 2-3 km
III – patient has spastic-paretic gait, difficulty to walk
and weakness on 200-300m
IV – patient can not to walk without help
V – patient can not to walk or has blindness