Demyelinating Diseases Flashcards

1
Q

What are some risk factors for developing MS?

A
  1. Being born in the North (Vit. D)
  2. Age 20-40
  3. Female
  4. Family Hx
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2
Q

What are 3 common presentations of MS?

A
  1. Optic Neuritis
  2. Intranuclear Ophthalmoplegia
  3. Transverse Myelitis
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3
Q

What is Optic Neuritis?

A

Acute Demyelination of the Optic Nerve (usually ant to chiasm so affects only 1 eye)

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4
Q

What condition presents as progressive monocular vision loss that appears as though looking through dirty dish water and has color desaturation?

A

Optic Neuritis

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5
Q

What should you do if a patient has Optic Neuritis?

A

Get an MRI

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6
Q

What will be seen on PE of Optic Neuritis?

A

Afferent Pupillary Defect (may still be present after sx)

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7
Q

What is intranuclear ophthalmoplegia?

A

A lesion in the brainstem that –> impaired horizontal gaze with failure of MEDIAL gaze when looking AWAY from the lesion

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8
Q

What condition results from a disconnect between the Abducens Nucleus and the Occulomotor Nucleus?

A

Intranuclear Ophthalmoplegia

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9
Q

Which eye will you see Nystagmus in with Intranuclear Ophthalmoplegia?

A

The good Eye

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10
Q

What is Transverse Myelitis?

A

Demyelination of the Spinal Cord

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11
Q

What condition could result in hemi sided weakness, sensory defects and bowel/bladder dysfunction?

A

Transverse Myelitis

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12
Q

Which neuroimaging modality is used for visualizing new and old regions of demyelination in MS?

A

MRI with T2 Flair Sequence

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13
Q

What abnormality is seen in the CSF of MS patients?

A

Oligoclonal Banding, high IgG/Albumin Ratio and elevated IgG

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14
Q

What is the treatment for an acute MS episode?

A

High Dose IV Methylprednisolone

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15
Q

What long term treatment option for MS works by decreasing T cell migration?

A

Interferon Beta

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16
Q

What long term treatment option for MS can be rendered ineffective by smoking due to Abs that develop against the drug?

A

Interferon Beta

17
Q

What are the side effects of Interferon Beta?

A

Flu like sxs (HA, arthralgias, myalgias)

18
Q

What long term treatment option for MS works by modulating the immune system through MHC?

A

Glatiramer Acetate

19
Q

What is the indication for using Glatiramer?

A

Long term treatment of less aggressive MS

20
Q

What is the main side effect of Glatiramer?

A

Chest Tightness

21
Q

What long term treatment option for MS that sequesters lymphocytes through binding of sphigosine 1 phosphate receptors?

22
Q

What long term treatment option for MS results in significant Bradycardia and Hypotension?

23
Q

What long term treatment option for MS interferes with Pyrimidine synthesis to block proliferation of T and B cells?

A

Teriflunomide

24
Q

What are the side effects of Teriflunomide?

A
  1. TERATOGENIC ***
  2. Alopecia
  3. Hepatotoxicity
25
What long term treatment option for MS targets the Nrf2 pathway involved in oxidative stress response to decrease lymphocyte levels?
Dimethyl Fumarate
26
What long term treatment option for MS is given for very aggressive disease?
Natalizumab
27
How does Natalizumab work?
Binds to Alpha 4 integrin of the BBB to prevent lymphocytes from entering the brain
28
What long term treatment option for MS is associated with Progressive Multifocal Leukoencephalopathy?
Natalizumab
29
Which demyelinating disease could present with sudden vision loss or loss of bladder function?
Neuromyelitis Optica (Devics)
30
What lab test would indicate Devic's Disease?
NMO IgG Antibody test (Ab against Aquaporin 4 Cl Channel)
31
What is the treatment for Devic's Disease?
Rituxumab