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Neurology > Demyelinating Disease > Flashcards

Demyelinating Disease Flashcards

1
Q

MS

  • Fatal?
  • Contagious?
  • Directly Inherited?
  • Always severely disabling?
A

NO

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2
Q

MS affects which brain matter

A
  • WHITE

* W/ some gray matter involvement

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3
Q

MS

Where?

A

Further away from Equator, higher your risk

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4
Q

MS

Cause?

A

UNKNOWN:
(Maybe):
*Vit D deficiency
*Virus (EBV) kicks off autoimmune

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5
Q

Involvement of cerebellum

A

Tremor

Ataxia

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6
Q

Involvement of medulla/brainstem

A

Sensory systems, Lhermitte’s, Pain, Proprioception

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7
Q

Involvement of Pons

A

Diplopia
Vertigo
Dysarthria
INO

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8
Q
  • Parastesia arms/legs
  • Monocular blindness
  • Slowly progressing motor deficit
  • fatigue
  • depression
  • Focal muscle weakness
  • bowel/bladder/sexual
  • gait
  • lhermitte
A

MS

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9
Q

MS s/s worse with

A

Heat, fever, hot water, exercise, menstruation, saunas

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10
Q

EDSS progress

A 
6 = 15 years
8 = 46 years
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11
Q
  • New recurrence of symptom
  • 24 hrs - weeks/month
  • will uncover in interview
A

MS Relapse

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12
Q

Confirming progression

A

+1 on EDSS

*2 consecutive visits 3 months apart

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13
Q

Attack, then back to baseline, then attack then back to baseline
*baseline may raise

A

Relapsing-remitting

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14
Q

Linearly gets worse

A

Primary progressive

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15
Q

Attack, then baseline (few cycles), then start linear raise

A

Secondary progressive

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16
Q

1ary progressive

Many will become….

A

2ary progressive

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17
Q

Overall MS Tx goal

A

Prevent Disability ACCUMULATION. (W/ increasing lesions/plaques = WHITE + gray matter)

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18
Q
  • Younger at onset
  • Female
  • Low MRI lesion load
  • Complete recovery from 1st relapse
  • Low relapse rate
  • No disability at 5 years

Prognosis?

A

FAVORABLE

NO to 2ary progressive

19
Q
  • Older age at onset
  • Male, AA
  • High MRI lesion load
  • No complete recovery after 1st relapse
  • Early disability of disability
  • Insidious motor onset
A

UNFAVORABLE

–>2ary progression

20
Q

MS

Major auto-immune attack cells

A

T cells

Cross BBB and attack myelin on WHITE matter (and grey)

21
Q

Demyelenation causes

A

Slower nerve conduction

PARTIALLY REVERSIBLE

22
Q

Axonal injury + destruction cause

A

PERMANENT neurological dysfunction

23
Q

Where are lesions?

A
  • optic nerves
  • Periventricular white matter
  • Cerebral cortex
  • Brain stem
  • Cerebellum
  • Spinal cord
24
Q

Crucial evidence in MS dx

A

Dissemination of lesions in space and time

25
Q

MS Dx

CSF

A
  • up IgG/albumin (serum + CSF)
  • Oligoclonal bands (CSF ONLY)
  • Normal glucose, cells, protein
26
Q

MS s/s

(white matter issues)

A

Devic’s Dz (NEUROMYELITIS OPTICA)

MIGRAINE

  • Infxn- lyme, pml, hiv
  • inflammatory - lupus, sjogrens, cns vasculitis, sarcoidosis, bahcet’s dz
  • Metabolic - b12, #
  • CNS lymphoma
27
Q

Image

Transverse myelitis more than 3 spinal segments

A

NOT MS

Neuromyelitis optica?

28
Q

Auto-immune

  • spinal cord= transverse myelitis
  • Optic nerves - optic neuritis (bilateral)
  • serum- IgG
A

NMO - Myelitis optica

NMO-IgG antibody

29
Q

MS Vs. NMO

A

NMO = bilat optic neuritis, white matter brain lesion, transverse myelitis, NMO IgG antibody

MS= OCB in CSF, White matter brain lesions

30
Q

Take MRI, see white matter lesions, but see gandolinium contrast enhancements in new area (new lesions)

A

DX MS

31
Q

How to confirm dissemination in space and time?

A

MRI

Enhancing w/ gandolinium contrast

32
Q

MRI, predicting prognosis

A

Lesion load

33
Q

TX goals

A

Less relapse

Less dz progression

34
Q

Tx

Acute relapses

  • 1 per year untreated
  • W/ Menstruation (heat)
A

1 per year in untreated

HIGH DOSE STEROIDS
Methylprednisone
Shorten episode

35
Q

Tx long term

A 
Immunomudolating Rxs (started in 90s)
Before only injection, now oral
36
Q

Interfeuron S.E.

A
  • injection site rxn
  • flu-like s/s
  • Neutropenia
  • up liver function tests
  • possible antibody formation
37
Q

Natalizumab

DANGER

A

JC Virus –> will develop PML (progressive multifocal leukoencephalopathy)

CHECK JC VIRUS ANTIBODY LEVELS ON THIS MED

38
Q

Relapses

MC reason?

A

Not taking Rx

39
Q

Best way to prevent s/s

A

Early detection/Tx start

40
Q

T1-weighted scan

A
  • Hypointense lesions *(black holes) - axonal damage

* old lesions

41
Q

T2 weighted scan

A
  • total disease burden
  • myelin damage
  • old + new lesions
42
Q

FLAIR image

A
  • Suppress CSF white color from t2
  • Best - dz burden
  • subcortical lesion ID
43
Q

Gandolinium Contrast w/ image

A

*new Lesion

Neurology (20 decks)

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