B6.044 Prework 1: MS Symptoms and Diagnosis Flashcards
central symptoms of MS
fatigue
cognitive impairment
depression
unstable mood
visual symptoms of MS
nystagmus
optic neuritis
diplopia
speech symptoms of MS
dysarthria
throat symptoms of MS
dysphagia
MSK symptoms of MS
weakness
spasms
ataxia
loss of balance
sensation symptoms of MS
pain
hypoesthesias
paraesthesias (tingling)
bowel symptoms of MS
incontinence
diarrhea or constipation
urinary symptoms of MS
incontinence
frequency or retention
primary factors influencing diagnosis of MS
no single test
based on clinical exam, history, lab tests, and MRI
based on lesions being disseminated in time and space
criteria for MS diagnosis
McDonald Criteria
importance of early/effective treatment of MS
limits permanent damage to the CNS
may slow or prevent conversion to a more progressive form
2 clinical attacks
2 lesions with objective clinical evidence
no other data needed
2 clinical attacks
1 lesions with objective clinical evidence
need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI
1 clinical attacks
2 lesions with objective clinical evidence
dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands
1 clinical attacks
1 lesions with objective clinical evidence
need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI
AND
dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands
4 types of MS
relapsing remitting (85%) secondary progressive (50% of relapsing remitting patients within 15 years) primary progressive (15%) progressive relapsing (?)
what is a relapse
- monophasic clinical episode with patient reported symptoms and objective findings typical of MS
- represent focal or multifocal inflammatory demyelinating event in the CNS developing acutely or subacutely
- duration of at least 24 hours
- with or without recovery
- absence of fever or infection
relapsing and remitting course
characterized by relapses with stable neurological disability between episodes
sequence of events in a relapse
symptoms develop over hours to days
symptoms can continue worsening for several weeks
symptoms slowly subside over weeks to months
residual symptoms can be present
definition of progressive MS
steadily increasing objectively documented neuro disability independent of relapses
fluctuation, periods of stability, and superimposed relapses might occur
events in progressive MS
gradual progression
often involves asymmetric leg weakness, ataxia, and spasticity
diagnostic criteria of progressive MS
- one year of disease progression
PLUS 2 of the 3:
-evidence for DIS in the brain based on >1 T2 lesions in at least 1 area characteristic for MS
-evidence for DIS in spinal cord based on >2 T2 lesions in the cord
-positive CSF for oligoclonal bands and/or elevated IgG index
different activity levels of progressive MS
active with progression (relapses and clinical deterioration not due to relapses)
active but without progression (relapses but no clinical deterioration)
not active but with progression
not active and without progression (stable)
what is clinically isolated syndrome
first presentation of neuro symptoms lasting at least 24 hours
caused by inflammation and/or demyelination
can be monofocal or multifocal
partial or complete recovery
high chance of developing MS
etiology of initial relapses in relapsing-remitting disease
frequent inflammatory events that reach over the clinical threshold
axon loss in relation to MS
early axon loss occurs
does not correlate with inflammation
clinical disability over time parallels axonal loss
axonal loss > clinical threshold initiated secondary progressive disease course
what can cause axonal loss
cyclical demyelination and remyelination events
appearance of MS lesions on T2 MRI
white lesions
appear fluffy
can appear in white matter, corpus callosum, and spinal cord
appearance of MS lesions on T1 MRI
IV admin of Gd reveals focal areas of BBB disruption
identified as high signal intensity regions
cortical lesions in MS
can occur early and may have some relationship with cognitive impairment and physical disability
some cortical lesions observed by pathological examination are not detectable by MRI
spinal cord lesions
sensory and motor deficits on one or both sides below the lesion
brainstem lesions
diplopia, ataxia, weakness, altered sensation of the face
optic nerve lesions
blurry vision
painful eye movements
cerebral lesions
most common
cause least amount of symptoms
many are silent
if very large: numbness or weakness or other cortical function
better prognostic factors for RRMS
female younger age white monofocal onset minimal cortical pathology onset w optic neuritis or isolated sensory symptoms low relapse rate high degree of remission after 1st relapse long interval to 2nd relapse mild relapse early ttx absence of oligoclonal IgG or IgM bands low disability at 5 years low lesion load on MRI
worse prognostic factors for RRMS
male older age nonwhite multifocal onset early cortical pathology onset w motor, cerebellar or bladder/bowel symptoms high relapse rate short interattack latency short interval to 2nd relapse severe relapse late ttx presence of oligoclonal IgG or IgM bands disability at 2 or 5 years abnormal MRI
