Demyelinating Diseases

Question 1

What is MS

Answer 1

Chronic inflammatory disease of the CNS, Brain and Spinal Cord

• Myelin is destroyed and underlying neurons and axons are then destroyed as well

Question 2

WHat is the pathologic lesion in MS

Answer 2

MS plaques- These occur when myelin is lost and inflammation and scar tissue build up

Question 3

Most common form of MS is

Answer 3

relapsing remitting- pts develop periodic loss of neurological function

Question 4

Uhtoff’s phenomena

Answer 4

MS symptoms that worsen during and increase in body temperature….occurs because of poor electrical conduction along demyelinating axons

Question 5

Define relapse

Answer 5

A new neurological disability that lasts at least 24 hours. Differentiated from stroke because relapse is subacute whereas stroke is acute

Question 6

MS plaques visualized on MRI?

Answer 6

Yes

Question 7

Spinal Fluid Profile of an MS patient?

Answer 7

IgG index elevated and oligoclonal bands (also present in infection of CSF) present

<Lymphocytes may be present but NEVER neutrophils

Question 8

Significance of “gadolinium enhancing MS plaque”

Answer 8

Gadolinium does not normally enter the brain parenchyma. In situations where there is active inflammation and breakdown of the blood brain barrier, gadolinium is allowed to enter

Question 9

MS plaques are ……… in nature

Answer 9

periventricular ( around a ventricle) and present in the deep white matter often adjacent to regions of cortical grey matter (juxtacortical)

Question 10

What do you use to stain myelin

Answer 10

Luxol fast blue stain

Question 11

At the edge of the plaque is a large inflammatory response made up of

Answer 11

• monocytes
• T and B cells
• Macrophages and microglia

Question 12

MS typically diagnosed in what age range

Answer 12

20-40, usually women

The gender ratio in primary progressive form is about equal

Question 13

Two most common types of MS

Answer 13

relapsing

progressive

Question 14

Median time to reach moderate disability with relapsing mS

Answer 14

15 years

46 years to severe disability

Question 15

How is MS diagnosed

Answer 15

• MRI
• Spinal tap
• Evoked potentials (measures brain’s response to visual, auditory, and sensory stimuli)

Question 16

Most common symptoms of MS

Answer 16

• Optic Neuritis- vision loss, central scotoma
• Myelitis- sensory symptoms in arms and legs as well as motor deficit
• Brainstem
• Cerebellum

Question 17

Know that MS plaques are

Answer 17

periventricular

Question 18

If the optic nerve is demyelinated there will be delay of the Visual Evoked Response, P100

KNOW

Answer 18

k

Question 19

What is a Clinically Isolated Syndrome

Answer 19

A clinical episode suggestive of an MS patients first relapse

Things often affected

Question 20

Transverse Myelitis

Answer 20

Acute neurologic condition that reflects focal inflammation of the spinal cord

• Acute or subacutely dveloping motor, sensory, shincter dysfunction
• Segmental layer of sensory disturbance with a well defined upper limit

No evidence of spinal cord compression…absence of other known neuro disease

Question 21

Look At NMO

Answer 21

ok

Question 22

Afferent pupillary defects seen in MS

Answer 22

yes. This is consistent with demyelination and axon damage

Question 23

What are your chances of developing MS after an episode of transverse of myelitis

Answer 23

ok