DemyelinatingDs_PretestStepup Flashcards
What is the classic location demyelination plaques of MULTIPLE SCLEROSIS?
ANGLES OF LATERAL VENTRICLES
How do you make a CLINICALLY DEFINITE MS diagnosis?
1) 2 Sx episode
2) Evidence of 2 white matter lesions (Imaging or clinical)
How do you make a LAB-SUPPORTED DEFINITE MS diagnosis?
1) 2 Sx episodes
2) Evidence of 1 white matter lesion (MRI) + Abnormal CSF oligoclonal bands
What constitutes a PROBABLE MS diagnosis?
1) 2 Sx episodes
2) 1 white matter lesion OR CSF oligoclonal bands
What is the most common initial presentation of MS?
Transient sensory deficits - DECREASED Sensation or parasthesia of UL/LL
What is the most common initial visual disturbance of MS? Which visual disturbance strongly supports the diagnosis of MS?
INITIAL = OPTIC NEURITIS - Central scotoma, pain on eye movement, decreased PERLL, monocular vision loss
STRONGLY SUPPORTIVE = INO
Describe a RIGHT Intranuclear ophthalamoplegia.
Right INO = Right MLF lesion = Inability to do LEFTWARD GAZE by RIGHT eye (R. CN III-mediated medial rectus/R.MLF involvement) + LEFT NYSTAGMUS (L. CN VI intact but brain is confused and saccades)
How long do MS relapses generally occur for? How many times do relapses occur? What is the general age group affected for an initial MS presentation?
RELAPSE Sx >24hrs
Average 1/yr
20-30s
What are risk factors of SEVERE DISABILITY of MS?
1) FREQUENT attacks early on
2) Onset at OLDER age
3) PROGRESSIVE course
4) Early PYRAMIDAL/CEREBELLAR involvement
What is the MOST SENSITIVE test for diagnosing MULTIPLE SCLEROSIS?
MRI
True or False: Number of demyelinated lesions on MRI correlates proportionally to disease severity/progression speed.
FALSE
Do NOT directly correlate
What are useful diagnostic tests for MS? (3)
1) MRI - Demyelinated lesions in 90% of MS pts
2) CSF - Oligoclonal IgG bands in 90% of MS pts
3) Nerve Conduction Study - Evoked potentials are abnormal (newly re-myelinated nerves conduct sensory impulses more SLOWLY) in 90% of MS pts
What is the recommended Tx for ACUTE ATTACKS of MULTIPLE SCLEROSIS?
HIGH DOSE IV STEROIDS
Can HIGH DOSE ORAL STEROIDS be used for ACUTE ATTACKS? Does Tx of acute exacerbations alter outcome or course of MS?
NO, high dose ORAL steroids does not have the same efficacy as IV steorids
NO, ACUTE TX does NOT result in any improvement of long-term course of MS
What are the two primary goals of MS therapy?
GOAL 1: Reduce relapses - IFN therapy, cyclophosphamide
GOAL 2: Reduce symptoms of acute exacerbations - baclofen/dantrolene, carbamazepine/gabapentin
When is the most ideal time for IFN therapy administration for MS?
EARLY in the course of disease before disability becomes irreversible
When is the most ideal time for CYCLOPHOSPHAMIDE therapy administration for MS?
LATE - Reserved for rapidly progressive disease bec there are many toxic AE
What are the pharmacological drugs to reduce Sx associated with acute exacerbations of MS?
1) Reduce muscle spasticity - BACLOFEN, DANTROLENE
2) Reduce neuropathic pain - CARBAMAZEPINE (trigeminal neuralgia), GABAPENTIN
3) Anti-depressant - If use is indicated
What are the classic features of MS?
1) OPTIC NEURITIS
2) LHERMITTE’S SIGN - barber chair sign electrical sensation down the back
3) UHTHOFF’S PHENOMENON (Worsening Sx with INCREASED body temp)
4) MOTOR/SENSORY DEFICITS
5) BOWEL/BLADDER DYSFN
How does TROCHLEAR N. PALSY present?
VERTICAL DIPLOPIA
Worsens - Eye looks down and towards nose (walking downstairs or reading)
Gets better - tilt head away and chin towards lesion
How does a TRANSTENTORIAL HERNIATION OF UNCUS (parahippocampal gyrus) during HEAD TRAUMA present?
1) Compression of IPSILATERAL CN III: IPSILATERAL DOWN/OUT/MYDRIASIS
2) Compression of CONTRALATERAL CRUS CEREBRI against tentorial edge: IPSILATERAL HEMIPARESIS
3) Compression of IPSILATERAL PCA: CONTRALATERAL HOMONYMOUS HEMIANOPIA
4) Compression of RETICULAR FORMATION: Altered LOC, COMA
What is the pathophys of TRIGEMINAL NEURALGIA?
Like MS, it is DEMYELINATION of TRIGEMINAL NERVE NUCLEUS OR NERVE ROOT
