Demyelinating Flashcards
A 30 year-old female presented with with double vision.
Multiple sclersois - Dawson’s fingers
A 30 year-old female presented with with double vision.
Multiple sclerosis - Juxtacortical lesions
A 30 year-old female presented with with double vision.
Multiple sclerosis - infratentorial lesions
A 30 year-old female presented with with double vision.
Multiple sclerosis - lesions in corpus callosum
A 50 year-old man developed personality changes and subtle left-sided weakness.
Multiple sclersois - Tumefactive lesion
- Clinical presentation is atypical for MS:
- Aphasia
- Visual field deficits
- Cognitive and personality changes
- Neglect syndrome
- Weakness and sensory deficits
- Biopsy is often taken for correct diagnosis
A 24 year-old man presented with left arm weakness.
Multiple sclerosis - Balos
A 34 year-old patient presented with double vision and left arm weakness.
Multiple sclerosis - incomplete ring-enhancing lesions
A 29 year-old woman presented with blurry vision and pain in her left eye for 3 days.
Multiple sclerosis - left optic neuritis
- Other conditions with optic neuritis:
- ADEM (acute disseminated encephalomyelities)
- SLE, Sjogren’s, Bechet’s
- Sarcoidosis
- Treatment
- 3 days of IV solumedrol
A 45 year-old female with cognitive impairment, ataxia.
Multiple sclerosis - black holes
- Older lesions appear hypointense on T1WI
A 34 year-old woman presented with several days of severe, progressive blindness.
Neuromyelitis optica (NMO)
- Bilateral inflammation of optic nerves, chiams, and longitudinally extensive myelitis
- Criteria for diagnosis
- Optic neuritis + myelitis
- 2 of 3 supportive criteria
- MRI evidence of spinal cord involvement
- MRI of brain nondiagnostic of MS
- NMO-IgG positive
- Epidemiology
- Women > men
- Africans > caucasians
- Treatment
- IV steroids or plasmapheresis
- MS treatment WORSENS NMO
A 45 year-old male with MS developed cognitive slowing and abulia.
Progressive multifocal leukoencephalopathy (PML)
- “Milky-way” pattern on imaging
- Medications that can cause PML:
- Natalizumab, fingolimod, dimethyl fumarate
An 8 year-old child presented with encephalopathy and seizures.
Acute disseminated encephalomyelitis (ADEM)
- Pathogenesis
- Central immune-mediated demyelinating inflammatory disorder affecting white matter of brain and spinal cord
- Occurs during or after systemic illness or vaccination
- Measles infection is highest risk
- Typically found in children
- Signs and symptoms
- Headache, lethargy, myalgia, malaise, fever, vomiting
-
Encephalopathy for 3-4 weeks
- Seizures, neuropathies, weakness, hemiparesis, sensory deficits, ataxia, aphasia, paresthesias, altered mentals tatus
- Diagnosis
- Perivascular inflammation in cerebral hemispheres, brainstem, cerebellum, spinal cord, optic nerves
- CSF is normal
- Treatment
- High dose IV steroids
- Then oral steroids + IVIG