Demyelinating Disorders - Krafts

Question 1

A 35 year old patient arrives in your office complaining of sporadic episodes in the last few months of muscle spasms, fatigue, and some double vision. She is very busy, but made time to come in due to recent problems with voluntary bladder control.

What do you think?

Answer 1

Multiple sclerosis!

Remember that Krafts emphasized EPISODES

Question 2

Abnormal laboratory finding in MS?

think spinal tap

Answer 2

Oligoclonal bands in CSF of MS patients

Question 3

What would you see in active and inactive MS plaques?

Why do you have both at once?

Answer 3

Having plaques in different stages and different locations is indicative of MS

Active plaques

• have lipid-stuffed macrophages
• T cells cuffing vessels

Inactive plaques

• have NO myelin
• decreased oligodendrocytes/axons
• gliosis!

Question 4

In a myelin stain method, what do plaques look like?

Answer 4

Basically just the pale area

Question 5

What are a few good generaly manifestations of central and spinal MS?

Remember can affect a lot of differnt things

Answer 5

CNS

• vision impairments
• cranial nerve signs

PNS

• motor or sensory impairment of limbs
• spasticity
• bladder control

Question 6

What is Acute Disseminating Encephalomyelitis?

Answer 6

Diffuse monophasic demyleination following viral infection

• usually kids
• rapid onset (headache, lethargy, coma)

Question 7

What is acute necrotizing hemorrhagic encephalitis?

Answer 7

Fulminant(fast) CNS demyleination after infection

• young adults/children
• very fatal
• hyperacute ADEM?

Question 8

What demyelinating problem can actually be caused by sodium therapy on accident?

Answer 8

Central Pontine Myelinolysis

treat hypnatremia with sodium and they become quadriplegic, caused by shifting of fluids out of the cells, preferentially affects these myelin cells

Kills myelin… thats bad