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CK_Neuro > Demyelinating Diseases > Flashcards

Demyelinating Diseases Flashcards

1
Q

Name three characteristic MS syndromes

A
  1. optic neuritis
  2. transverse myelitis
  3. intranuclear ophthalmoplegia
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2
Q

How can optic neuritis present?

A

loss of acuity
red desaturation (decreased ability to distinguish color)
optic disc atrophy/pallor
RAPD

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3
Q

How can transverse myelitis present?

A

PATCHY inflammatory demyelination in spinal cord…partial lesion does not mimic complete cord transection

can present with unilateral/bilateral weakness or sensory loss below lesion. Can have bowel/bladder incontinence. Tingling/pain around torso at level of lesion.

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4
Q

How does INO present?

A

inability to adduct eye during contralateral gaze with nystagmus of abducting eye; convergence is SPARED

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5
Q

tingling electric sensation down the spine when patient flexes neck

A

Lhermitte’s sign

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6
Q

worsening of MS symptoms in the heat

A

Uhthoff’s phenomenon

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7
Q

discrete episodes of neurologic dysfuction that resolve after a period of time

A

relapsing remitting MS

relapses = “flares”

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8
Q

recovery from each MS relapse is incomplete and baseline function deteriorates

A

secondary progressive

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9
Q

relentlessly progressive course from onset of MS with superimposed relapses

A

progressive relapsing

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10
Q

relentlessly course from MS onset with NO relapses

A

primary progressive

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11
Q

features predicting good prognosis for MS

A 
young age of onset
female
primarily sensory symptoms
mild relapses with little/no residual deficits
optic neuritis WITHOUT MOTOR SYMPTOMS
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12
Q

what imaging modality good for picking up new MS lesions

A

T2 MRI
FLAIR

t2 hyperintesne ovoid lesions are classic

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13
Q

Classic CSF finding MS

A

oligoclonal bands

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14
Q

mechanism of oligoclonal bands on CSF

A

intrathecal production of IgG antibodies by plasma cell clones

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15
Q

Besides oligoclonal bands what else can MS CSF show?

A

moderate pleiocytosis and elevated protein

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16
Q

what can visual evoked potentials be used for?

A

document evidence of old optic neuritis

17
Q

chronic treatment options for MS

A

interferon beta 1a/1b
glatiramer acetate
natalizumab
fingolimod

18
Q

natalizumab increases risk of?

A

progressive multifocal leukoencephalopathy

19
Q

What labs to get before starting interferon?

A

CBC and LFTs

can cause leukopenia and transaminitis

20
Q

MOA natalizumab

A

monoclonal antibody against alpha 4 integrins that prevents lymphocytes and monocytes from crossing BBB

21
Q

MOA fingolimod

A

mixed agonist/antagonist of sphingosine 1p1 receptor (first oral MS med; all others are injectable)

22
Q

what must be monitored when patient is on fingolimod

A

ECG watch out for bradycardia and heart block

23
Q

symptomatic treatment options for MS spasticity

A

baclofen, tizanidine, diazepam

24
Q

symptomatic treatment for MS bladder dysfunction

A

anticholinergic agents and intermittent self cath

25
Q

presents similarly to MS except usually after viral antecedent or vaccine

A

acute disseminated encephalomyelitis

26
Q

acute disseminated encephalomyelitis vs. MS

A

Unlike MS, ADEM patients will…

  • only have one phase (monophasic) and will usually recover well
  • rarely show oligoclonal bands
  • have more cells with lymphocytic pleocytosis
27
Q

neuromyelitis optica (NMO) = ? + ?

A

development of optic neuritis and transverse myelitis

28
Q

MS vs. NMO

A

NMO patients unlike MS, will have

  • greater pain component in ON/transverse myelitis
  • CSF pleocytosis sometimes neutrophilic predominance
29
Q

How to confirm diagnosis of NMO

A

antibodies to the aquaporin 4 channel

30
Q

dementia, focal cortical dysfunction, cerebellar abnormaliteis

A

progressive multifocal leukoencephalopathy (PML)

31
Q

What conditions associated with PML?

A

immunosuppressed states, AIDS, leukemia/lymphoma

32
Q

causative agents PML

A

JC virus! (leads to demyelination by infecting oligodendrocytes)

33
Q

patient presents with aucte confusion and cortical vision loss (blindness with preserved pupil reactivity) in the setting of rapid HTN or on transplant immunosuppressants?

A

posterior reversible encephalopathy syndrome

PRES

CK_Neuro (8 decks)

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