CH35: Multiple Sclerosis and Other Demyelinating disease Flashcards
Dominant mechanism in MS (p. 938)
Antibody and complement myelin phagocytosis
Histologic subgroups in MS (p. 938)
I: inflammatory lesions made up of T cells and macrophages
II antibody lesion mediated by Ig and complement
III: apoptosis of oligodendrocyte and absence of Ig complement and partial remyelination
IV: oligodendrocyte dystrophy and no remyelination
Strongest association is with ___locus on chromosome ___ (p. 939)
DR locus on chromosome 6
Inheritable allele for MS
HLA
IL 2Ra
IL7Ra
Temporary induction by heat or exercise of symptoms such as unilateral visual blurring (p. 941)
Uthoff phenomenon
Flexion of the neck may induce a tingling, electric-like feeling down the shoulders and back (p. 941)
Lhermitte sign
An object such as a pendulum that is swinging perpendicular to the patient’s line of sight appears to move in a three- dimensional, circular path (p. 942)
Pulfrich effect
Charcot triad (p. 944)
Nystagmus
Scanning speech
Intention tremor
In MS, used to control spontaneous attacks (p. 945)
Carbamazepine
In MS, blocks the painful tonic spasms that are elicited by hyperventilation (p. 945)
Acetazolamide
Seres of concentric rings that represent alternating areas of melin loss and preservation (p.947)
Concentric sclerosis of Balo
OCB are only found in how many percent? (p. 948)
90% of cases of MS
OCB can also be found in (p.948)
syphilis, Lyme, SSPE
IgG index positivity (p. 948)
a positive test is considered to be greater than 12% of the total protein
MS vs abscess in CT (p. 949)
C-shaped partial or open ring of abnormal enhancement
Is there progressive cerebral atrophy in MS?(p. 949)
Yes
Measures the back-scattering of near-infrared light to create extremely high resolution cross- sectional images of the optic nerve and retina (p. 949)
Optical coherence tomography
MS and pregnancy (p. 951)
Average relapse rate declines in each trimester reaching a level less than one third of the expected rate by the third trimester
Behcet vs MS (p. 952)
In Behcet, recurrent iridocyclitis and meningitis, mucous membrane ulcers of mouth and genitalia; symptoms are articular, renal, lung, and multifocal cerebral disease
The first drug of MS (p. 952)
ACTH
First interferon for MS (p. 953)
Glutamer acetate
In 2006, IV monoclonal antibody for MS (p. 953)
Natalizumab but became limited due to risk of JC virus hence PML
Given to patients before taking Interferon (p. 954)
Prednisone 10mgtab 1 hour before
A rare side effect of monoclonal antibody for MS (p. 954)
Systemic capillary leak syndrome
MOA of Natalizumab (p. 954)
directed against alpha integrin in order to block lymphocyte and monocyte adhesion to endthelial cells and their migration through the vessel wall
Murine B cell depleteing monoclonal antibody that targets CD20 (p. 955)
Rituximab
Fully humanized anti CD 20 drug (p. 955)
Ocrelizumab
A monoclonal antibody which targets CD 52 antigen expressed on T and B lymphocytes (p. 955)
Alemtuzumab
A drug that reduces annual relapse rates by approximately one-third to one-half and has gastrointestinal side effects and flushing (p. 955)
Dimethyl fumrate
Sphingosine 1 phosphate 1 receptor analogue that interferes with egress of mature lmphocute from lymph node (p. 955)
Fingolimod
Suppresses the immune system by inhibiting dihydro-orotate dehydrogenase and suppressing the synthesis of DNA pyrimidine bases (p.955)
Terfunomide
Agents such as 4-aminopyridine (p. 956)
improve conduction though demyelinated central nerve fibers by blocking potassum channels
Reduce proxysmal symptoms in MS, particularly truncal extensor spasms (p. 956)
Carbamazepine or Gabpentin
Alternative to oral baclofen (p. 956)
Tizanidne
MS vs NMOSD pathophysio (p. 957)
NMOSD is humoral in contrast to prmarily cellular-immune mechanism in MS
In ADEM, how many days the rash does encephalomyelitis occur? (p. 960)
2-4 days
