In this chapter, we analyze two key pathologies based on autoimmune demyelination of the central nervous system: multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM). These are diseases in which the immune system mistakenly attacks the myelin sheath of its own nerve fibers, leading to severe neurological deficits.
The section consists of two topics. First, we will study multiple sclerosis in detail—its clinical forms, the phenomenon of symptom "fluctuation," and modern disease-modifying therapies (DMTs). Then we will move on to ADEM—an acute monophasic disease that usually manifests after infection or vaccination. The main clinical task here is to learn how to distinguish ADEM from the first attack of multiple sclerosis.
During classes, instructors are sure to ask you about Charcot's classic triad and Marburg's pentad, ask you to explain the essence of retrobulbar neuritis and the principles of pulse therapy. Pay special attention to the McDonald criteria: a clear understanding of the concept of dissemination in space and time is your main key to successfully passing the exam.