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ICC3 > differential diagnosis of multiple sclerosis > Flashcards

differential diagnosis of multiple sclerosis Flashcards

1
Q

what symptoms are unlikely to be the first presentation in MS ?

A

seizures
dementia
dysphagia
pain
movement disorder
systemic affection - skin lesions
normal MRI

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2
Q

what are the common inflammatory phenocopies that could be DD of MS ?

A

transverse myelitis
neuromyelitis optica
ADEMS
Sarcoidosis
SLE
Behcet syndrome
Cerebral Vasculitis

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3
Q

what is transverse myelitis ?

A

inflammation of the spinal cord

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4
Q

what are the causes of TM ?

A

MS
para infectious
post vaccination
para neoplastic
systemic autoimmune

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5
Q

what do we give to a patient with TM ?

A

pulse steroids

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6
Q

what is the nature of the lesion in TM ?

A

takes more than 3 segments ( unlike MS has a shorter segment )

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7
Q

What is NMO or Devics disease ?

A

neuromyelitis optica
optic neuritis plus myelitis
plus 2 or 3 of :
brain MRI is normal no MS
longitudinally extensive cord lesion
NMO igG (aquaporine 4 positive )
it is an autoimmune disease

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8
Q

in what race is NMO more commonly seen in?

A

Japanese people

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9
Q

what is the response of NMO to steroids ?

A

optic neuritis here is usually very severe and doesn’t respond to steroids

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10
Q

what is the suggestive treatment for NMO ?

A

pulse steroids and plasmapheresis

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11
Q

what is ADEM ?

A

acute disseminated encephalomyelitis that is mono-phasic so only presents with 1 attack that affects the brain and the spinal cord

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12
Q

If we have a child presenting with MS like symptoms what is crucial to ask about in history ?

A

post vaccination
post infection

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13
Q

what are the causes of ADEM ?

A

post infectious
post vaccination

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14
Q

what is the presentation of ADEM ?

A

cortical presentation so an affection of grey matter more
so
fever
seizures
headache
subconscious levels

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15
Q

what do we give a patient with ADEM ?

A

pulse steroids

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16
Q

If we have a child presenting with fever , seizures and headaches what could be the possible diagnosis ?

A

ADEM

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17
Q

what do the lesions in MRI of ADEM look like ?

A

huge lesions on MRI

18
Q

what is sarcoidosis ?

A

an multisystem inflammatory disease characteristic with a non caseating granuloma

19
Q

what race is common in sarcoidosis ?

A

afro-carribeans

20
Q

what are the presenting symptoms of sarcoidosis ?

A

cough
dyspnea
systemic rash
weight loss
uveitis
parotitis
lymphadenopathy

21
Q

what is the presentation of neuro-sarcoidosis ?

A

meningeal infiltration causing headaches, seizure
cranial nerve affection

22
Q

which nerve is commonly affected inn neuro-sarcoidosis?

A

7th cranial nerve

23
Q

do we find any meningial infiltration in MS ?

A

no meningeal infiltration

24
Q

what is the triad of Behcet’s disease ?

A

oral ulcers ( asasi)
genital ulcers ( painful)
uveitis
skin lesion

25
Q

in which nationality is behcet more common in ?

A

turkey > asia > western
males

26
Q

what test is diagnostic in Behcet’s ?

A

pathergy test
erythematous papules that lasts for more than 24 hours

27
Q

what can be seen in neuro-behcets disease ?

A

psychiatric complications
cerebral venous thrombosis

28
Q

what is SLE ?

A

autoimmune multi-system organ affection with a malar rash , discoid rash , serositis , arthritis

29
Q

what are the labs for SLE ?

A

ANA dsDNA antibodies

30
Q

what are the features of neuro-lupus ?

A

neuro-psychiatric presentation
painless optic neuritis
chorea

31
Q

what is sjorgren’s syndrome ?

A

xerostomia
xerophtlamia
rheumatoid arthritis

32
Q

what is the immunological panel for Sjorgen’s syndrome ?

A

Anti-ro
anti- la

33
Q

“autoimmune disease of the brain”

A

cerebral vasculitis , its non specific

34
Q

what is the clinical presentation of giant cell arteritis ?

A

jaw claudication
temporal headache
biopsy of the temporal artery is diagnostic

35
Q

what is another diagnostic feature of sarcoidosis ?

A

increased ACE levels

36
Q

what is the disease course for devics disease ?

A

poor recovery between attacks

37
Q

what is the diagnostic test for sjogren syndrome ?

A

Schirmer’s test
to test if the eye produces enough tears

38
Q

what does normal aging look like on imaging ?

A

fazekaz
peri ventricular caps

39
Q

how can you see CADASIL on brain MRI ?

A

extension from the ventricles

40
Q

what symptoms may point towards spondylopathy ?

A

pain in their back
pain on movement

ICC3 (66 decks)

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