Demylination

Question 1

we are not born with ____ and it first forms _____

Answer 1

myelin, first in the peripheral

Question 2

examples of demyelination diseases:

Answer 2

monaa (ms, “I’m on, no, ade, i can go to the- atm)

Question 3

ms is an _______

Answer 3

autoimmune disease that attacks myelin

Question 4

we think MS comes about bc of:

Answer 4

a virus like ebv causes antibodies to be made against the bodies own cells

Question 5

4 different presentation patterns

Answer 5

scales: progressive-relapsing
scale-gliss: secondary progressive
relapsing-remiting

Question 6

episodes of demyelination followed by times of quiet, and again times of demyelination:

Answer 6

relapsing-remitting

Question 7

most common relapse people with ms experience:

Answer 7

optic neuritis: film over the eye, pain, soapy water film over eye, etc

Question 8

20% of Ms patients will eventually have ____

Answer 8

optic neuritis, it comes and goes and will get better and worse

Question 9

can’t see the ritardando?

Answer 9

can optically see the new rit….

Question 10

________ is a condition in which there is _______ of the spinal cord

Answer 10

Ascending transverse mylitis: demylination of the spinal cord, ascending demylination of the spinal cord that feels like a tight band around your waist, and the ATM is taking it

Question 11

common symptoms

Answer 11

dvorak concerto in F played By the super sexy diggeridoo native

Question 12

ms first shows with:

Answer 12

optic neuritis (vision problems), and then asymmetrical or bilateral myelopathy in one leg (numbness)

Question 13

symptoms:

Answer 13

dvorak concerto in f played by super sexy native diggeridoo player

Question 14

mnemonic for neuritis:

Answer 14

can’t optically see the new rit: neuritis

Question 15

to diagnose MS you need:

Answer 15

time and space: it takes time to show relapse, and there has to be a collection of clinical symptoms

Question 16

if you only have one demyelination symptom___ if it is the same neuritis again ________

Answer 16

it is not ms, it is just a one time occurance; it is just an optic nerve problem

Question 17

andre dawson:

Answer 17

dawson’s fingers with a jherri curl

Question 18

What do you treat with MS?

Answer 18

DRES: exasurbation, then treat with steroids vitamin D (prevention)

Question 19

prevention of relapse?

Answer 19

IV version uses monoclonal antibodies

Question 20

MS is more prevelant in areas further from the equator and it also has been shown to be related to:

Answer 20

vitamin d deficiency

Question 21

another demyelination disorder is ______ associated with eyes

Answer 21

NMO, neuromyelitis optica (remember the fish in water with glasses)

Question 22

in ______ autoantibodies attack ____ and it is common in _____

Answer 22

neuromyelitis, proteins in the Aquaporin 4-gene attack AQP4 on the surface of astrocytes

Question 23

the aquaporin-4 gene mutations are found in:

Answer 23

the surface of astrocytes, brain, spincal cord, optic nerves

Question 24

if you were able to regrow myelin, the neuromyelitis would be termed _____ as opposed to:

Answer 24

MS, NMO

Question 25

NMO is also known as:

Answer 25

Devic’s disease

Question 26

the difference in sagital ct between ms vs devic’s or nmo

Answer 26

ms is usually responsible for a lesion that covers 2 vertebral segments, where as nmo covers a great deal more (auqaoporins)

Question 27

PML:

Answer 27

viral, caused by jc virus, immunocompromised (aids)

Question 28

jc met natalie and he ended up losing everything

Answer 28

natalizumab came out to treat ms and it unded up causing jc virus

Question 29

check patients for jc virus antibodies, if they have it ____ if not____

Answer 29

dont put them on natiluzamab, if not, it should be fine

Question 30

ADE:

Answer 30

acute disseminated encephalomyelitis

Question 31

symptoms:

Answer 31

affects children, AMS, cotton balls in brain on ct, treat with steroids (most always a post infection disorder)

Question 32

PML ct vs ADE:

Answer 32

ade has cotton balls in both hemispheres, while pml has cotton balls in only one

Question 33

cetnral pontine myelinoslysis:

Answer 33

cauldran pot of salty soup (too much at once bc someone in a hospital is given too much salt), difficult to talk or swallow because it’s too damn salty

Question 34

ct scan for cpm:

Answer 34

right smack dab in the middle with steam rising up from the pons

Question 35

on ct, vertebrate of ms covers ____ while atm covers ______

Answer 35

2 (ms) 3 or more (NMO)

Question 36

ADE vs MS

Answer 36

inditinguishable on MRI but occurs accutely on single occasion and not recurrent like MS. Develops within days or weeks of a viral illness or an immunization. ADE usually produce perivenous demyelination with sparing of the nerve axons

Question 37

2 weeks after recovering from illness (virus), 19 yr old complains of headache and neck stiffness. Has a fever and soon has deteriorated cognitive function. Becomes disoriented, lethargic, increasingly unresponsive, MRI shows damage to white matter of cerebral hemispheres

Answer 37

ADE Acute Demyelination encephalomyelitis

Question 38

one presentation of ____ is a spastic bladder characteristic of ______

Answer 38

ms, upper motor neuron

Question 39

23 yr old woman awaken with bilateral leg weakness, numbness, urinary retention and impaired bowel control. She has had several episodes of blurred vision over the previous 2 years but always been attributed to idiopathic papillitis:

Answer 39

neuromyelitis optica,

Question 40

_____ produces signs and symptoms of bilateral optic neuritis in association with a transverse myelitis.

Answer 40

neuromyelitis optica

Question 41

____ exhibits paraparesis, bladder and bowel disfunction and sensory deficit signal a transverse myelitis that is an inflammatory demyelinating lesion that transects much of the spinal cord. All similar to MS but generally less circumscribed pattern of deficits

Answer 41

neuromyelitis optica

Question 42

a 54 yr old alcoholic is brought to ed with profound agitation. Believed to have delirium tremens and is treated with thiamine and intravenous fluids. Serum sodium is noted to be markedly depressed and iv supplements are adjusted to rapidly correct this hyponatremia He becomes acutely quadriplegic and unresponsive and dies within 24 hours

Answer 42

central pontine myelinolysis

Question 43

rapid correction of hyponatremia in an alcoholic precipitate ______

Answer 43

central pontine myelinolysis

Question 44

_____ is a rapidly fatal demyelinating disorder of the brainstem

Answer 44

central pontine myelinolysis

Question 45

____ is often seen in persons affected with hypokalemia, hypochloremia and hypomagnesemia, hyponatremia have low serum osmolality and findings consistent with the syndrome of inappropriate antidiuretic hormone

Answer 45

central pontine myelinolysis

Question 46

35 yr old woman with progressive numbness of right arm and difficulty seeing objects in the right visual field. Known to be hiv positive with homohemianopsia and decreased sensory perception in right upper extremity. MRI shows a demyelinating lesion of the left parietoocciptial area, and CSF PCR for JC virus is positive

Answer 46

PML, double stranded dna virus, haart therapy, always jc virus

Question 47

27 yr old man develops recurrent episodes of involuntary movement. He is an iv drug user, with bacterial endocarditis. Involuntary movements are largely restricted to the right side, lost 40 lbs over 4 months, and has difficulty swallowing. CT shows large area of decreased density on left side of cerebrum, and eeg shows slowing over the left side of the head. Biopsy of lesion reveals oligodendrocytes with abnormally large nuclei and extensive demyelination with giant astrocytes in the lesion. Develops dementia, seizures, and bladder incontinence.

Answer 47

PML

Question 48

patients with aids, inclusion bodies in oigodendrocyte nuclei (JC virus) multiple focal well defined white matter lesions that do not enhance or have mass effect

Answer 48

PML

Question 49

a myelogram is performed on a patient with a subacute, worsening paraparesis. The MRI of the lumbar of the spinal cord shows a patchy enhancement at L4-5.

Answer 49

Acute Transvere Myelitis

Question 50

in _______, there is inflammation that is largely limited to the spinal cord, and there need not be any mass effect. This is present with a variety of noninfectious processes (MS) or infectious processes i.e. viral or parasitic

Answer 50

Acute Transverse Myelitis