DSA 35 Multiple Sclerosis

Question 1

what is the diagnostic criteria for MS?

Answer 1

1. ) two attacks and clinical evidence of two separate lesions
2. ) two attacks; clinical evidence of one lesions and preclinical evidence of a separate lesion

Question 2

what constitutes clinical evidence?

Answer 2

1. ) spastic weakness of leg
2. ) diminished sensation in a part of the body
3. ) evidence of optic neuritis on funduscopic exam

Question 3

what constitutes paraclinical evidence?

Answer 3

1. ) abnormal MRI findings

2. ) abnormal evoked potentials

Question 4

if MS patient presents with vertigo or facial numbness, how would you explain these findings?

Answer 4

MS is damaging the white matter tracts leaving the vestibular and trigeminal nuclei respectively. the nuclei are gray matter so they themselves are not damaged.

Question 5

what is the difference between MS symptoms and MS attack?

Answer 5

patient with MS may have sensory symptoms that come and go lasting seconds or even constant. an MS attack is a new symptom that always lasts longer than 24 hours and may last for months.

Question 6

how might an old MS lesion (cavitation in white matter surrounded by gliosis) appear on MRI?

Answer 6

MRI would show it as a black hole

Question 7

true or false: demyelinating lesions may also be found in the spinal cord.

Answer 7

true

Question 8

what are two characteristics seen in the CSF of 95% of the patients with MS?

Answer 8

IgG oligoclonal bands and elevated IgG index

Question 9

what is the IgG index?

Answer 9

% of IgG in the CSF compared to serum

Question 10

how does the CSF findings in neuromyelitis optica differ from MS?

Answer 10

CSF lacks oligoclonal bands and elevated IgG index

Question 11

what is frequently seen on MRI of neuromyelitis optica patient?

Answer 11

demyelination of white matter in the cervical spinal cord

Question 12

what is the clinical presentation of neuromyelitis optica?

Answer 12

patients typically present with optic neuritis and signs/symptoms of cervical myelopathy

Question 13

what demographic is predominantly affected by MS?

Answer 13

young adults (12-50s), median age 35. F > M

Question 14

how long do exacerbations (relapses) always last?

Answer 14

> 24 hours

Question 15

what are the most common presenting symptoms in MS?

Answer 15

1. ) paresthesias usually unilateral
2. ) optic neuritis
3. ) focal weakness either 1 limb or 1 side
4. ) vertigo
5. ) diplopia
6. ) ataxia
7. ) facial pain

Question 16

what drugs can be given to shorten the length of exacerbations?

Answer 16

corticosteroids

Question 17

true or false: brain MRI findings in neuromyelitis optica are usually abnormal.

Answer 17

false, they’re usually normal

Question 18

which drugs may be effective in treating neuromyelitis optica?

Answer 18

corticosteroids and azathioprine

Question 19

sensory disturbance is MS is not due to?

Answer 19

nerve root lesions–this is PNS. MS does not affect the PNS

Question 20

weakness in MS is not due to?

Answer 20

anterior horn cell lesion

Question 21

visual disturbance in MS is not due to?

Answer 21

retinal lesion–everything behind the retina is CNS, it is all myelinated.

Question 22

bladder dysfunction in MS is likely due to?

Answer 22

thoracic myelopathy

Question 23

in MS patient, what will often show on funduscopic exam?

Answer 23

inflammation. may see some raised optic disc margins or hyperemia of disc margins.

Question 24

what diagnostic tests would you order for patient with suspected MS?

Answer 24

always do brain MRI with and without contrast unless contraindicated