Demyelinating diseases of CNS

Question 1

Multiple sclerosis

Answer 1

Loss of myelin, preservation of axons, women more than men, whites
Sx: optic neuritis - painful loss of visual acuity in one eye, loss of color discrimination/blurriness, papilledema
transverse myelitis - inflammatory demyelination in spinal cord, particular tracts interrupted
internuclear ophthalmoplegia - MLF issues
lhermitte sign - tingling with electric sensation
uhthoff’s phenom - worsening sx in heat
Course: relapsing-remitting course evolving into secondary progressive course
Dx: MRI, CSF has oligoclonal bands, visual evoked potentials
Tx: acute - steroids, IVIG and glatiramer, natalizumab, fingolimod

Question 2

Acute disseminated encephalomyelitis

Answer 2

Monophasic illness leading to areas of demyelination
Sx: similar to MS
Dx: clinical presentation and radiologic findings

Question 3

Neuromyelitis optica

Answer 3

Transverse myelitis and optic neuritis with pain
- aquaporin 4 antibodies
- simultaneous or delayed
Dx: MRI and CSF pleocytosis

Question 4

PML (progressive multifocal leukoencephalopathy)

Answer 4

Sx: dementia, focal cortical dysfunction, cerebellar abnormalities
- seen in AIDS, leukemia, lymphoma patients
Cause: JC virus

Question 5

PRES (posterior reversible encephalopathy syndrome)

Answer 5

Develops in HTN and eclampsia or immunosuppressants used to prevent organ transplant rejection
Sx: acute confusional state and cortical visual loss
Dx: MRI with post white matter hyperintensities