Demyelinating Conditions Flashcards
acute disseminated encephalomyelitis
monophasic illness leading to demyelination of DNA following viral infection or vaccination; initially, difficuly to distinguish from MS
features of CNS lesions in ADEM
lesions are multiple, more patchy, bilateral and confluent –> predilection for posterior cerebral hemispheric white matter
how can you clinically ddx ADEM from MS
in ADEM, there are behavioral and cognitive abnormalities as well
DX of ADEM
- radiologically
- CSF: lymphocytic pleocytosis, elevated protein (NO oligoclonal bands)
tx of ADEM
short course of IV steroids
neuromyelitis optica
optic neuritis and transverse myelitis (can either be simultaneous or gap of even 2 years between the two); demyelination of the brain is absent –> deficits tend to be more severe than in MS
MRI of spine in neuromyelitis optica
lesions that extend over several segments of the spinal cord
CSF findings in neuromyelitic optica
neutrophilic pleocytosis
Dx of NMO
antibodies to aquaporin 4 channel
Tx of NMO
IV steroids
chemotherapeutic agents
plasmaphoresis
progressive multifocal leukoencephalopathy
dementia, focal cortical dysfunction and cerebellar abnormalities due to JC viral infection which causes demyelination through infection of oligodendrocytes
who gets PML?
AIDS pts
leukemia/lymphoma pts
pts taking monoclonal ab’s
immunocompromised states
Dx of PML
MRI shows multiple foci of white matter changes esp in posterior regions of bain; CSF is normal
Tx of PML
not effective, mortality is 50%
posterior reversible encephalopathy syndrome
leukoencephalopathy that develops in context of rapidly developing HTN and eclampsia OR due to immunosuppressants for organ transplant recipients –> acute confusional state and cortical visual loss (blindness with preserved pupillary reflexes)
