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Friday, February 4, 2011

DEMYELINATING DISEASE

Demyelinating disease are characterized by breakdown of myelin in CNS only and are supposed to be secondary to an autoimmune or viral etiology. Three types are known:


1.Schilder disease manifests with cortical blindness, optic neuritis, cortical deafness, spastic hemiplegia or paraparesis, aphasia, convulsions, and, at a later stage, dementia and coma. Raised intracranial pressure occurs only occasionally. partial remission may occur rarely.

2.Multiple sclerosis manifests by cerebellar ataxia, spasticity, retrobulbar optic neuritis and atrophy, diplopia, and blindness. Course is relapsing and IQ is preserved till late. Therapeutic ,measures include short courses of ACTH, physiotherapy, treatment of UTI and bladder care. Symptom-free remission for many years are known.

3.Neuromyelitis optica (Devic disease) manifests with eye pain and blindness followed in some days by spinal cord involvement in the form of first lower motor neuron and then upper motor neuron paralysis of the legs. Upper level of sensory involvement is in thoracic area. Fundoscopy may show swelling and hyperemia of disc, distension of retinal veins and peripapillary hemorrhages. A 5 to 7 day course of dexamethasone ( high doses) is indicated. Vision usually returns but some paraparesis persists..

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