Demyelinating Diseases Flashcards
What are some risk factors for developing MS?
- Being born in the North (Vit. D)
- Age 20-40
- Female
- Family Hx
What are 3 common presentations of MS?
- Optic Neuritis
- Intranuclear Ophthalmoplegia
- Transverse Myelitis
What is Optic Neuritis?
Acute Demyelination of the Optic Nerve (usually ant to chiasm so affects only 1 eye)
What condition presents as progressive monocular vision loss that appears as though looking through dirty dish water and has color desaturation?
Optic Neuritis
What should you do if a patient has Optic Neuritis?
Get an MRI
What will be seen on PE of Optic Neuritis?
Afferent Pupillary Defect (may still be present after sx)
What is intranuclear ophthalmoplegia?
A lesion in the brainstem that –> impaired horizontal gaze with failure of MEDIAL gaze when looking AWAY from the lesion
What condition results from a disconnect between the Abducens Nucleus and the Occulomotor Nucleus?
Intranuclear Ophthalmoplegia
Which eye will you see Nystagmus in with Intranuclear Ophthalmoplegia?
The good Eye
What is Transverse Myelitis?
Demyelination of the Spinal Cord
What condition could result in hemi sided weakness, sensory defects and bowel/bladder dysfunction?
Transverse Myelitis
Which neuroimaging modality is used for visualizing new and old regions of demyelination in MS?
MRI with T2 Flair Sequence
What abnormality is seen in the CSF of MS patients?
Oligoclonal Banding, high IgG/Albumin Ratio and elevated IgG
What is the treatment for an acute MS episode?
High Dose IV Methylprednisolone
What long term treatment option for MS works by decreasing T cell migration?
Interferon Beta
What long term treatment option for MS can be rendered ineffective by smoking due to Abs that develop against the drug?
Interferon Beta
What are the side effects of Interferon Beta?
Flu like sxs (HA, arthralgias, myalgias)
What long term treatment option for MS works by modulating the immune system through MHC?
Glatiramer Acetate
What is the indication for using Glatiramer?
Long term treatment of less aggressive MS
What is the main side effect of Glatiramer?
Chest Tightness
What long term treatment option for MS that sequesters lymphocytes through binding of sphigosine 1 phosphate receptors?
Gilenya
What long term treatment option for MS results in significant Bradycardia and Hypotension?
Gilenya
What long term treatment option for MS interferes with Pyrimidine synthesis to block proliferation of T and B cells?
Teriflunomide
What are the side effects of Teriflunomide?
- TERATOGENIC ***
- Alopecia
- Hepatotoxicity
What long term treatment option for MS targets the Nrf2 pathway involved in oxidative stress response to decrease lymphocyte levels?
Dimethyl Fumarate
What long term treatment option for MS is given for very aggressive disease?
Natalizumab
How does Natalizumab work?
Binds to Alpha 4 integrin of the BBB to prevent lymphocytes from entering the brain
What long term treatment option for MS is associated with Progressive Multifocal Leukoencephalopathy?
Natalizumab
Which demyelinating disease could present with sudden vision loss or loss of bladder function?
Neuromyelitis Optica (Devics)
What lab test would indicate Devic’s Disease?
NMO IgG Antibody test (Ab against Aquaporin 4 Cl Channel)
What is the treatment for Devic’s Disease?
Rituxumab
