ryosthen io

ALS

ultiple
Sc\ eros

6uill
iS

qn

ravis
Fxn

0orrg

ru

'Thlroid
'

Lobofot()fJ Tesl s

[f) : con,f irms Dr (-) : ooes not rlo n6 sen fn of0tein g

EMo qnd NCv test s
ileqsurtg dectricol omqvirl i$ nuscle

ACeillCholiI\0 neceptor Antibodres i ncntf

'creqtinine Ki n0se (cK) CSF ' .f lgc imnunog protein ,-${6c t in AUS

'.'iiiuitts

tnqle: 55-l1o fern0le t zo -ft6

musc I e

ini'

o tec{roonofes i (Q{ols tOrimmune dr\

Hll\l,*ol,ltilo',, o' frters

Singl e {ruer il16 nost

sensitire ti{e netr6!sCUtor sPe(iflt t{) tl6

AP

roscirurqtrons o{the

CSF: f ir\ protein wlo f in cettcounT : nofmol ll mpho(lt8 cSF.electruPtplesrs c0unt . t rnmlelin nusic pnofet 0lood Tests: woc ProsenS of IgGHrndS ll, leuRocYtOSf S oliqoslonq I bonds) q15y6iq,prtol eeriln @st ns Pdnents serurn:l{M lqA, sioor cutiurel c'JUunl Defive rt n0 t in q afosslJ Abnormol in Neurtrporh y oduonced drseose oepressed veloflttes dfrer 3 weeRs norm0l t,lBrlCT to rlO drher
cqu s es

ll.$Pglffill"*
0iognostic, lmoqinq
PFT'S
or A66's

oI come b0CK

or

lLqt

CxR I Thlnomq

CT ECon

rnqrter qn0 nS p\qQue$ r'rnt: Dfglldg for t4 s Shorrs wnlte ptqques

Abnorm0t

CT i tdensitl of whit0

vvitqt cqpocitl
illol lg rl'5 t )
fl\uscle

t a2r.'l

ABGs:

tvitol copqgily t Pq0n f PoCOr or rph

0+ner
HOW IS

Tensilon resT
'1 FSpOnSe to

Se

riot

TKlrnq:
de$ecit
e,

$ofor streoqth

v0rOd P0ren+iql:
0bnorm0l
-t 2 qilocxsseponoted in uo single Jindrng f me ond smco c(lnf lrms clx.

dtoq nos f s

tmmed f 0re ty coof irmecf Rqstcl

or\c\inicot

mdde
me

1.

tiotlnbrg

19 crrug 5

0iognostic tes+ tind 4 b't tuting out other

cuuseg

nf
S

'mRl )csr {indings ) evo[ed Porcntio-l r{rhg Ctio o ttoc betq

I.

elidencg

vtdicq+ion

tnmunosuPPf'

essqnfS

i'm-esifnBii', ieg on o t ) con+icoste rsids gI hemo ooents lc' pro0u"ce remissto0 srmpt0rnS

Affii-chglinesrer0Se Aqents rvfodostiqmiile

Mq BID eiten"ctf iur vi vol ti

5O

Ri\uzole

(F,i\uteKl lin+erfer0r\
me

rnduced cerr nervedqmqgel

n qcuie exclterbqtlons Cyt0x0n,soluF\edrol, tmu rq l\ 0r rnefhof rex$e, C.ltoxin To srquitire t rhr dneqse
Pnocs

cor+icosterotd s - o i$f

lv lE
)tosmq
Phenesis

Mo1 ng uSQd+or 0cUrc tseqse rngmt of. q tong.

errn optlon

b eK(h0nqes over 0 2 wK period w"t {lu exchonges weeKt,l or rnonthll

.onii biotic
g

w;in dqlsof onsei yp to 30 da!s

3-r{
:To mqinrq ln opilmon fun ctfon in g 4 end o r tfe
6oAL

rx r'rdays

Moy need o

apqft tndround

llh ef

'

'0ntivirols
'bowe\ oids

rreqrS\hptoms 0s +hel oicun 1 rhoriilRqneuro\epttc) iiiefiterminq.l rest-

porostheslos) ' qntl chCIlinerg i cs ( utoddt '$eto-B\ocxens

qnriinttqnmoton] s 'bowgt qiqq . 0nti Con.rulso0ts t fo l

'Poiq a norphine . urt luRt {Anribiotrcs

ressniss d contuslon bs o 0 ' h{ ricnaogo ra

-.

..

.^- d'tsf rn
"

t vqsoPftssorS olti -( o og . DntT groprrt I

' llIpoTN
.

neurontin

Tlefn0rs

Nl0n

e{est0ti00s
.

M\oS+hen iq

pNS ro!is 6

cNS ALS

l,lot o r

s(tv'rel latodderdtsf 'imite turns to o snqr I qrrn S . il n t.t utr I r'xn(impotence' .Fociql weoKnesS . Beqinnttlqmugcle 'frtiicrl wegrness 4 qil6phr in orrns 'Ntst6gYnU g sPostlcltq 'EXtr00cul0r utions (twitcn 'oisor+nn io "D'ts Phogtt 'FQsgicut .piptoPiq' rrrYsto$nuS M0{e fl\entg oT the fOce .siofomos ( aperrP! ) 'Chqwinq lswqtl0N in9 sse s titston

: elg.[l$g I progressr\,g Eqntt s\mptorYls :6niue ntrbphl rnt'scle weqKnes$ tmpro{es T fest 'Fotiqu. urhi le tot rinq . Drsoithr i0( Slurfed sp, . P00f Postufg jiPloPio ' t..ltisql otlulft 1 of 'lolce 'ptt, si'i-' etQ 'DlsPhoqiq 'weqrllnqsnPtet .vulnrnelsinnunds { CtoSUf0

swmetntl t\^ot()f n i i dubus sensrti virl yuoKn0SS to temperotune) .Flexor Spdsmsotntgh' v

crr

lFqtique I (qssoctote nttt .Ascendinq

ffi

Mrrttip\e
S c\ero St
S

pNs

ui t\on B0rf e

tr siS .hrentfon +re{nofs.r riqccid vltrtlou't mu S'cl 'oisrn et ri o ( illlllil*-n r otiroPhg . ft$tiq ( I rrromr coord.) 'gor obSent cleep
,

poro

xnS

'*endon net lexeS '. RespirotorJ comprornise t Fqiluf(

'LOSSOtnOrr.ret
Q

. speech ( n0s0tTwofq' 'muscle qtK,pht4 lei do') voice recomes weoK)' rii.oi s eltern c' c ,Respir0torl rruscl0 . rongqe F issuf S . R e sp1 ro tori ComP rurust lf\ {o t tle$enf 'Loss o{ bowe\ f ntodder itspirotorl cornPftro' * cont r0 t

Di{ti c(rties

S I ll9fe

'

pqrqt\ s ts cq n ue

u.!J-g!g!gl

r'

coordr'n o tlon ) cront'o1 Nerve tnvolv. . Focfot w0Q Koe sS

,Atoxiq ( vmotor

btoddercon$o\ ( tess comrn0n)

i"b.

fotique

Deqth

poor coordfnqtron crurns.| Moto r Mvmt t o n nr OefOctive eleep tendoii ref lrts

.0.'Sph0gt0 'Drploptq .orfflcurrryspedHnq 'hqbilitr tochew or S

rnile

Senso

rq

.Muscle Achiness . PqrqSthe si 0\

,

$r

nttectd4'

'tvf suol
qc
'

treoning

uit.f

p0rqsthestos Poin or cr1npinq

sleep

tsme\\ {toste

P0r0srheti 0\ ..1, sense 0t ternp'

ql+erqilon3

'ri nnitus{ringing in eotS, dizzlness't

,Hrp0l0esi0 ( senS' iti'rtti to poin'\

lognitire

g0nsc\0

llJ

usness is coqni+ive A's ooss ib lg o \te red' ' thi0rinQ Ond

n-ot

'pxoct (0use ond exttn rnqtlenrlveness :Lqte fn diseuset ettoUlished)

not \pic0lly Loc,. t Prubl em sotvirrq obilttt cereurol fxn *CIbl'lit'l T0 pertorrn Pfttcesse! Cqtc ul0 t lsn S P\qnn\ng rmpqirbcl ludqemefl
DoeS

Memc,nJ L0ss

atfect

t{ood

Ps',lchosocio\

Depressl0n guphont0 Embtronq lobil npoth'1

NOT

itg
pfessure cqYdioc slsrhlTlntos rochl condiq
Lqbile b\00d

Aut0nom r c

Muscle AtruphY ?

tl\

hnpll

smqll 't'0 Setle

)ES

es, Ne r0 LocK 0+ use

NO

M\qstnenlq onoliS
PNS

AL5
CNS

wlutriprg

Sclerosis
cNS

ouittonBqrre
PNg

[9J o diseqse

Pothoph', s-

iolog9

Aqlttqntibodl 0ttocx Ng lsguln Equse ln Ach RKePtff in tte t-oss ordeqth o0 trnnt nuscle enOploftS breors connecflonS \efve irnsltse oren't rmnsT\itted io muscle wlunnN
nnzummUs3ul0r XXn i ci t 1 rnrrruSclt nusiles con't controct :SpoSt :0+rque ondweoxness weorness {, tnrgordipgt tOfl n rnutctes rnnervoted rycr0niql ner{es. ;getol dresPirotonf

Chqrqcrer ized
bV?

nusctes
E

ilemsess

Sneo*h , lthtcnoesl phero t nerveS tJernr etenlzotlon\ { conduction o.t U cond'qct i on o S lmpu r se s . i6pulSeS "Excict (,qUSe unKno$r unKnown couq.0 Exqcerhottons qncl Ascending eonotlsis lernrssi onS ,sudde n onset otr e ,lu muscl wsg(ness Ond Poifi" :eo+ures v0t'9.
n0st common newo. Mrddle oged drsorder in oiderqduH men >wo/nen )nS$ uSUql\r: 20 -tl0 ffi,n,hxo$qss0c. i l\ne sse s fri6"i["e n 7 6 g 11, rincidor jglflilr0 ilt aeqree

lnf I qmfnfi0rJ respofis( Aut0immune qtto(K on ff\..|etin ot peri' dqm00es mletin

tioloq't

RlsK FoctotSl

tncidenct
Progfessi
0

PeqKAge : 20-30IrS usu otl.rlo - rlo \fs . wo$en lx > nen tinCidente urltoch ^N\ uor hercditonl i6mitiol incidence decq0e USS ) vrofiio{\

A6E

Rfifl

ieli1j:,.ilrcrqtrons

ur0 . Arner. > 0ther r0ct

0nset : lnsiduos qsu0il t4uscle ArropnJ

)eriodso
gxqsTe

s6qfrof\

Rernission

cur0b I e

tRem i Ssi on e

or

Associq ted ir\nesses Flperplqsio ot the rhlTIlUS q\qnd n

rned icqt io S.

r,nodsot rBmrston 4 Atuleonset (t-rlwFs). { :xosterbotitn nrnrch Plotequ ( uP to 2\lrt$ F rn s0{er\t lAf requencg Recover-l(usuol\1 q.t . rncludinQ :qnrcodro pefrnonent il;i-,';i' ii-i.1eois\ bod.,f reioirororr mutcles dornnoe E voives 6ver noursto dqvs wlrre0+ment Pt\Nrll N0 Knou,tn c ufg wtjn 3 ieors ,10,, *noqr,l. oeoth No($\ot uit{ ExPecmncq ffifill!!..trrp,utu. rrp(o. Sor tu fe) NUle ilhess- 6r itl-ness PoSstnJu ttrql 6 xp\ori10 t0r0rCqnpJ loboci ef f eJ u nt boct ,

6eqlns rflo0e'or Spfeoc\s to entir0

t,tc.

ihlmonq 'iimt rlpertnlroidtsm 'envifonlnentql D-p$icillert0st, or q(ilrs interferon- otPhO qsposs inle cquses

octions o'f .qenetic

tnqger

lN0 s\nq\ertfUS

rdrntiiied.

Fr{ . rnjcoptosmo pnetffi 0nl( Sufqerl, uR\ r' inut : d.rr mPqotov rfu s

vocrinotron : Flu .6ltuP AStrgp' Robies

*

iti'rii:Gii
k\l\

{qrwet\o

Oruqg : qOPtOPri t, Oonmo I

LlllPl *

dq

x,r*