Demyelinating Diseases Flashcards
Epidemiology of Multiple Sclerosis
Affects about .5 million people in US - lost in NE and northern latitudes (if you spent the first 15 years of life there). It is diagnosed between 20-40 and women tend to get it more than men (3:2).
What are the types of MS?
Relapsing Remitting MS
Secondarily Progressive MS
Primary Progressive MS
Progressive Relapsing MS
Relapsing Remitting MS
most common form of MS characterized by an initial isolated event (single sx) that may or may not resolve to normal followed by other events of demyelination and increasing disability causing a cumulative effect.
Secondarily Progressive MS
2nd most common form of MS, starts with an initial episode then progressed with increased neuro deficits in between discrete episodes (usually still some relapsing and remitting to it). This type is more aggressive and less responsive to tx.
Primary Progressive MS
It is thought that this might be a whole different disease - it is characterized by no sudden onset or distinct episodes, just a gradual decline in neuro fx due to demyelination.
Progressive Relapsing MS
Combo of progressive diasability and some relapses and remissions
Does the extent of MRI damage always correlate with the amount of disability you see clinically in an MS patient?
NO! Very hard to correlate and you might see old lesions but no lesion that explains the current symptoms.
Is early recognition and tx important for MS?
YEP! Earlier tx is correlated with a better prognosis.
What is an MS exacerbation?
It is when a s/sx lasts more than 24 hrs (but can be days-wks). It must be isolated by at least 1 month from a separate exacerbation to be considered new. Happens when T cells are activated and attack the oligodendrocytes in the CNS.
What is a common first symptom of MS?
optic neuritis
How do you diagnose MS?
There must be multiple lesions separated by space and time.
- atleast 2 neuro events separated by at least 30 days (clinically or MRI)
- 2 anatomic events supported by objective findings (MRI, neuro exam)
What are the categories of MS diagnosis? (McDonald Criteria)
At risk - Clinically Isolated Syndrome (1 event + 1 objective finding)
Probably MS - 1 objective finding + 2 symptomatic episodes (or vice versa)
Clinically defined MS - all criteria are met (2 + 2)
What are common locations for MS brain lesions?
periventricular, juxtacortical, infratentorial, spinal cord
Can you diagnose MRI with 1 image?
yes - if there are isolated enhancing and non-enhancing lesions that fulfills the criteria for separation in space and time.
What can be found in the CSF of MS patients?
> 3 oligoclonal IgG bands or eleavated IgG index (IgG in CSF vs IgG in serum)
