MULTIPLE SCLEROSIS WITH MASSIVE PULMONARY ARTERY THROMBO-EMBOLISM

Multiple sclerosis (MS) is a chronic demyelinating disease, which is based on a complex of autoimmune and neurodegenerative processes leading to focal lesion of the central nervous system (CNS), axonopathy, which in turn leads to a disruption in the functions of the central nervous system. Today in Ukraine, more than 20,000 MS patients, at least 85% of whom have already become disabled due to impaired motor function, vision, coordination, pelvic functions. The article presents a case of sectional observation of multiple sclerosis in a woman of 43 years with the most pronounced changes in the brain and spinal cord, pulmonary arteries, deep veins of the right lower limb, and lungs. Macroscopically, the brain has been reduced in volume and the spinal cord is thinned. Multiple dense grayish-pinkish plaques of various shapes, dense consistency, up to 0.3 cm in diameter were found around the lateral ventricles in the white matter zone, in the visual intersection, quadruple, in the lateral and anterior columns of the spinal cord in which microscopic examination revealed zones of demyelination and depletion cerebral tissue, perivascular lymphocytic infiltrates, hyperplasia and hypertrophy of astrocytes, fibrocellular gliosis with loss of oligodendrogliocytes and the presence of numerous lipomas macrophages in the surrounding area is noted the development of degenerative changes in neurons and reduction in the density of their location. In the lumen of the pulmonary trunk in the area of bifurcation, the right and left pulmonary arteries, their share and segmental branches, brownish, darkish cordlike formations with a diameter of up to 0.5 cm with a matte surface, not welded to the artery wall, are found. In the lumen of the deep veins of the right tibia, multiple dark red, dry masses with a dull surface are identified attached to the wall of the vessels and their lumen surrounding them. Microscopically, in the masses extracted from the lumen of the pulmonary artery, a thromboembolism structure was found with the initial characteristics of the organization. The light sleepers, in the middle lobe of the right lung and lower lobes of the lungs, are subpleurally determined by one dry patch of dark-brown cone-shaped shape measuring 10x7 cm, 4x2 cm and 4x2 cm, respectively. When microscopic examination in the lungs in the lumen of the small branches of the pulmonary artery, thromboembolism have been found out, obstructing their lumen, adjacent areas of the lung with signs of hemorrhagic infarction. Thus, in the described case demonstrates a second-progressive course of multiple sclerosis with a lesion of the periventricular zone of the cerebral hemispheres, quadruple, intersection of the optic nerves, spinal cord. The main disease was complicated by tetraparesis with a sharp restriction of motor activity, which along with the autoimmune nature of the disease was a predisposing factor in the development of deep vein thrombosis of the right lower extremity with massive pulmonary artery thromboembolism, which caused the patient's death.