Approach to Multiple Sclerosis Flashcards
Patients with MS can present with many neuro symptoms. List 4.
- Paresthesias
- Gait disturbance
- Weakness
- Optic Neuritis
What is MS?
Multiple lesions over space and time
– due to myelin loss in CNS
Multiple lesions over space and time
Multiple Sclerosis
What is the most common type of MS?
Relapsing Remitting = periods of exacerbation and remission
Describe Secondary Progressive MS
Patient begins with Relapsing Remitting MS
–> Steadily decline with occasional relapses
Will there be relapses with Primary Progressive MS?
No
When do MS patients usually get diagnosed?
In their 20s and 30s
Can one single test confirm MS?
NO
What causes MS?
Unknown
Which sex is affected more commonly with MS and which sex has a more favorable course?
WOMEN for both
The ____ the onset for MS, the more favorable course
EARLIER onset = favorable course
What types of lesions will be seen on an MRI of the head/cervical/thoracic spine with MS?
Ovoid lesions
What are typical CSF lumbar puncture findings with MS?
- Oligoclonal bands
2. Increased IgG index/synthesis rate
What are typical CSF lumbar puncture findings with MS?
- Oligoclonal bands
2. Increased IgG index/synthesis rate
What is MS?
Multiple lesions over space and time
Most of the drugs for MS are used in the Relapsing Remitting form. Which one can also be used for Primary Progressive?
Ocrevus
What medications can be used to treat an acute exacerbation in MS?
- High dose corticosteroids
- ACTH or IVIg if the patient cannot have corticosteroids
What is on the differential diagnosis list when considering MS?
CIS = Clinically Isolated Syndrome
What types of episodes are options for Clinically Isolated Syndrome (CIS)?
- Monofocal episode
2. Multifocal episode
Monofocal episode of CIS
SINGLE neuro sign due to a SINGLE lesion
Single neuro symptom due to a single lesion
Monofocal episode of Clinically Isolated Syndrome
Multifocal episode of CIS
MULTIPLE neuro signs caused by lesions in MULTIPLE places
– but only at a single time (DOES NOT EQUAL MS)
Multiple neuro symptoms caused by multple lesions
Multifocal episode of Clinically Isolated Syndrome
What is another name for a Multifocal Episode of CIS?
Acute Disseminated Encephalomyelitis (ADEM)
If a CIS patient has MULTIPLE demyelinating lesions, what kind of risk do they have for developing Multiple Sclerosis?
HIGH risk
If a CIS patient does NOT have multiple demyelinating lesions, what kind of risk do they have for developing Multiple Sclerosis?
LOW risk
What is another name for Neuromyelitis Optica?
Devic’s Disease
What is Devic’s Disease (neuromyelitis optica)?
Demyelination of optic nerve and spinal cord
How do the affected segments of the spinal cord look with Devic Disease?
Long segments of spinal cord demyelinated
What will be present in the blood and CSF to diagnose Devic’s Disease?
Aquaphorin (NMO) Antibodies
