Demyelinating Flashcards

1
Q

A 30 year-old female presented with with double vision.

A

Multiple sclersois - Dawson’s fingers

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2
Q

A 30 year-old female presented with with double vision.

A

Multiple sclerosis - Juxtacortical lesions

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3
Q

A 30 year-old female presented with with double vision.

A

Multiple sclerosis - infratentorial lesions

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4
Q

A 30 year-old female presented with with double vision.

A

Multiple sclerosis - lesions in corpus callosum

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5
Q

A 50 year-old man developed personality changes and subtle left-sided weakness.

A

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
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6
Q

A 24 year-old man presented with left arm weakness.

A

Multiple sclerosis - Balos

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7
Q

A 34 year-old patient presented with double vision and left arm weakness.

A

Multiple sclerosis - incomplete ring-enhancing lesions

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8
Q

A 29 year-old woman presented with blurry vision and pain in her left eye for 3 days.

A

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
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9
Q

A 45 year-old female with cognitive impairment, ataxia.

A

Multiple sclerosis - black holes

  • Older lesions appear hypointense on T1WI
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10
Q

A 34 year-old woman presented with several days of severe, progressive blindness.

A

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
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11
Q

A 45 year-old male with MS developed cognitive slowing and abulia.

A

Progressive multifocal leukoencephalopathy (PML)

  • “Milky-way” pattern on imaging
  • Medications that can cause PML:
    • Natalizumab, fingolimod, dimethyl fumarate
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12
Q

An 8 year-old child presented with encephalopathy and seizures.

A

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
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