Demyelinating Diseases Flashcards
What is MS
Chronic inflammatory disease of the CNS, Brain and Spinal Cord
- Myelin is destroyed and underlying neurons and axons are then destroyed as well
WHat is the pathologic lesion in MS
MS plaques- These occur when myelin is lost and inflammation and scar tissue build up
Most common form of MS is
relapsing remitting- pts develop periodic loss of neurological function
Uhtoff’s phenomena
MS symptoms that worsen during and increase in body temperature….occurs because of poor electrical conduction along demyelinating axons
Define relapse
A new neurological disability that lasts at least 24 hours. Differentiated from stroke because relapse is subacute whereas stroke is acute
MS plaques visualized on MRI?
Yes
Spinal Fluid Profile of an MS patient?
IgG index elevated and oligoclonal bands (also present in infection of CSF) present
<Lymphocytes may be present but NEVER neutrophils
Significance of “gadolinium enhancing MS plaque”
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
MS plaques are ……… in nature
periventricular ( around a ventricle) and present in the deep white matter often adjacent to regions of cortical grey matter (juxtacortical)
What do you use to stain myelin
Luxol fast blue stain
At the edge of the plaque is a large inflammatory response made up of
- monocytes
- T and B cells
- Macrophages and microglia
MS typically diagnosed in what age range
20-40, usually women
The gender ratio in primary progressive form is about equal
Two most common types of MS
relapsing
progressive
Median time to reach moderate disability with relapsing mS
15 years
46 years to severe disability
How is MS diagnosed
- MRI
- Spinal tap
- Evoked potentials (measures brain’s response to visual, auditory, and sensory stimuli)
Most common symptoms of MS
- Optic Neuritis- vision loss, central scotoma
- Myelitis- sensory symptoms in arms and legs as well as motor deficit
- Brainstem
- Cerebellum
Know that MS plaques are
periventricular
If the optic nerve is demyelinated there will be delay of the Visual Evoked Response, P100
KNOW
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What is a Clinically Isolated Syndrome
A clinical episode suggestive of an MS patients first relapse
Things often affected
Transverse Myelitis
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
Look At NMO
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Afferent pupillary defects seen in MS
yes. This is consistent with demyelination and axon damage
What are your chances of developing MS after an episode of transverse of myelitis
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