#10: MS/transverse Myelitis

Question 1

abnormal eye adduction B/L and unaffected eye horizontal Nystagmus

Answer 1

Internuclear Opthalmoplegia

Question 2

visual acuity changes with increasing temperature

Answer 2

Uhthoff Phenomenon

Question 3

Pt flexes neck and notices “electric shock sensation” or vibration or pain radiating down back, and often arms and legs

Answer 3

Lhermette’s Sign

Question 4

MS first line treatment options: (3)

Answer 4

1- Interferon B-1a (rebif, aconex)- IM weekly
2- Interferon B-1b (Beterson, extavia)- SQ alternate days
3- Glatiramer acetate (copaxone)- SQ QD

Question 5

Supportive SXS tx for MS: (4)

Answer 5

1- spasticity (Baclofen)
2- neurogenic bladder
3- depressive SXS
4- Fatigue (Modafinil, Provigil)

Question 6

Tx for MS w/ disseminated Zoster dz: (2)

Answer 6

1- Fingolimod (Gilenya)

2- Alemtuzumab (Lemtrada)

Question 7

Tx for MS acute exacerbation:

Answer 7

• 1 gm IV solumedrol likely x3 days (determined by Neurologist)
• F/u with: PO prednisone 60-80 mg x1 wk short burst course and tapered over 3 wks

Question 8

Tx for acute disseminated encephalomyelitis as initial presentation of MS: (2)

Answer 8

• IV IG

- Plasmapheresis

Question 9

acute disseminated encephalomyelitis typically occurs following:

Answer 9

viral infx (measles and CP)

Question 10

etiology associated w/ acute disseminated encephalomyelitis:

Answer 10

• initial MS attack

- MC children (<11 y.o.)

Question 11

Initial SXS on presentation associated w. acute disseminated encephalomyelitis: (3)

Answer 11

• single episode of neuro SXS and signs that develop over a few days
• fever
• HA
• confusion

Question 12

Additional SXS that develop w. acute disseminated encephalomyelitis: (3)

Answer 12

• sensory disturbance in the legs
• flaccid weakness
• urinary retention (+ cord involvement)
• extensor plantar responses
• occasionally SZ and meningeal irritation