Provide a brief overview of the key elements that distinguish between Myasthenia

ID: 139513 • Letter: P

Question

Provide a brief overview of the key elements that distinguish between Myasthenia gravis, multiple sclerosis, Parkinson’s and Alzheimer’s disease. How can disorders of coagulation cause ischemia, thrombosis, and bleeding?
Provide a brief overview of the key elements that distinguish between Myasthenia gravis, multiple sclerosis, Parkinson’s and Alzheimer’s disease. How can disorders of coagulation cause ischemia, thrombosis, and bleeding?
Provide a brief overview of the key elements that distinguish between Myasthenia gravis, multiple sclerosis, Parkinson’s and Alzheimer’s disease. How can disorders of coagulation cause ischemia, thrombosis, and bleeding?

Explanation / Answer

Multiple sclerosis

Myasthenia gravis

Parkinson’s disease

Alzheimer’s disease

Caused by immune-mediated, progressive demyelination of central nervous system

Affects the Peripheral nervous system.

It is an autoimmune disorder affects the neuromuscular junction

Affects CNS

Occurs with the deficiency of dopamine due to the destruction of cells in the basal ganglia.

Alzheimer’s is a progressive, irreversible, degenerative disorder and is the most common cause of dementia.

-Mainly seen in 20-40 age groups
-Gender difference: more in women than men

Women are usually diagnosed in 20s-30s

Males are usually diagnosed in 70s-80s

- Idiopathic

Early-onset and

Late-onset (after 65) are present.

-Signs and Symptoms occurs depends on the location of the lesions.
-Visual disturbances due to lesions on optic nerve are very common
-Fatigue
-Pain
-Depression
-Weakness
-Limb numbness
-Coordination difficulties
-Altered sensory function
-Spasticity
-Ataxia

-Cognitive impairment

-Ocular symptoms saw the dropping of an eyelid

-Bulbar symptoms
*Lower cranial nerves symptoms like slurred speech, difficulty swallowing and chewing
-Generalized weakness
*Muscle groups
-Symptoms are usually worse during afternoon and evening

Cardinal Manifestations

T: Tremor

R: Rigidity

A: Akinesia /Bradykinesia

P: Postural disturbances

Other signs and symptoms are

-Excessive sweating

-Flushing

-Orthostatic hypotension

-Urinary retention

-Constipation

-Sexual dysfunction

-Cognitive /psychiatric changes

-Dysphonia

-Dysphagia

- infection risks: respiratory infection, urinary tract infections, skin breakdown, falls

In MS weakness is often associated with changes in sensation.

For a person with new onset of weakness, a doctor will assess whether it's accompanied by changes in sensation, which doesn't usually occur in myasthenia gravis but often appears in MS.

To diagnose MS the criteria includes a detailed neurological exam, medical history, spinal fluid analysis and magnetic resonance imaging, or MRI, of the brain and spinal cord.

No change in sensations occurs with weakness.

Presence of antibodies against the acetylcholine receptor or another antibody called anti-MuSK.

electrical measurement of muscle-nerve interaction.

testing after use of a drug to enhance acetylcholine aids in diagnosis.

Diagnosis:
-Tension test
-EMG
-Antibody Titers
(Tension: an anti-cholinesterase inhibitor, improvement after the administration of a drug is considered as a positive sign)

Definitive: post-mortem exam of brain tissue

EEG

MRI

PET

Blood tests: CBC, chemistries

Mini-Mental Status Exam

How can disorders of coagulation cause ischemia, thrombosis, and bleeding?

Any threat or injury to the body will trigger the coagulation mechanism. As a result, the coagulation proteins travel to the injury site to arrest the bleeding process. The abnormal activation of the coagulation factors throughout the body can lead to the development of DIC. The causes can be inflammation, infection, or cancer.

Disseminated intravascular coagulation (DIC) is a disorder characterized by systemic activation of blood coagulation leads to generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndromes (MODS).

In cases like DIC small blood clots form in the blood vessels and some of these clots can clog the vessels and cut off the normal blood supply to the vital organs like the liver, brain, or kidneys. Lack of blood flow can cause ischemia and cause major injury to the organs. The clotting factors in the blood are consumed and impose a high risk of serious bleeding, even from a minor injury or without injury. The bleeding may start spontaneously also. This coagulation disorders also cause the healthy red blood cells to fragment and break up when they travel through the small vessels that are filled with clots.

The derangement of the fibrinolytic system further contributes to intravascular clot formation or accelerated fibrinolysis and may cause severe bleeding. The patient with DIC can present with a simultaneously occurring thrombotic and bleeding problem.

DIC itself is not a specific illness, rather occurs as a complication or an effect of the progression of other illnesses.

The hematologic derangements in DIC result from the following simultaneously occurring mechanisms like:

- TF-mediated thrombin generation

- Dysfunctional physiologic anticoagulant mechanisms as seen in a depression of anti-thrombin and protein C system, which causes the imbalance in thrombin generation

- Depression of the fibrinolytic system causes impaired fibrin, usually caused by high circulating levels of plasminogen activator inhibitor type 1 (PAI-1) or in some cases fibrinolytic activity may be increased and contribute to bleeding

- Inflammatory activation