Dymeyleination & ataxia Flashcards
MRI usually shows ____ with acute disseminated encephalomyelitis (ADEM)
bilateral symmetric inflammation
is ADEM mono or polyphasic
mono
ADEM usually occur due to
infection or vaccine
sx of acute transverse myelitis
back pain
sensory level noted
sphincter disturbance
paraparesis
acute transverse myelitis is usually limited to ____ vertebral segments
2
_____ could be the 1st episode of MS
transverse myelitis
optic neuritis sx
loss of red vision
monocular blurring or loss
central blind spot
pain with eye movement
_____ is a very common initial symptoms of MS
optic neuritis
what is the leading cause of non-traumatic disability in young adults?
MS
Dawson’s fingers indicates
MS
vitamin ____ levels should be checked with MS
D
risk factors for MS
vit D deficiency
young, 20-30
female
what is the most common type of MS?
relapsing-remitting sclerosis
what is MS?
movement of autoreactive T cells and demyelinating antibodies from the systemic circulation into the CNS through disruptions of the blood-brain barrier
what is the most common symptom of MS?
spastic paraparesis
which pathways are affected later in MS?
cerebellar
what is the most common sensory tract lesion in MS?
spinothalamic
what is Lhermitte’s Phenomenon?
electric sensation passing down the back and limbs upon flexion of the neck
occurs with MS
which CN has neuralgia due to MS?
trigeminal (CN 5)
bc 1st 1/2 of it is oligodendrocytes
what is internuclear ophthalmoplegia?
occurs with MS
d/t medial longitudinal fasciculus
inability to adduct ipsi eye
nystagmus with contra eye abduct
what is Uhthoff’s phenomenon?
seen with MS
condition is worsened with heat
____ dementia is seen with MS. what is it?
subcortical
information processing, visuospatial, memory, and executive function issues
MS is diagnosed when there is new lesions within ___ months on an MRI
3
what are oligoclonal bands? what do they indicate?
presence of 2 or more antibody clones
indicates damaged blood-brain barrier or immunoglobulin production in the brain
MS diagnosis requires _____ for a diagnosis
evidence of at least 2 areas of damage at different times
MS diagnosis needs a separation in _____ and _____
time and space
what treatments affect the long term prognosis of MS?
disease modifying treatments
what is progressive multifocal leukoencephalopathy?
severe demyelinating disease of CNS d/t reactivation of JC virus infecting oligodendrocytes
difference between progressive multifocal leukoencephalopathy and MS flare up
progressive multifocal leukoencephalopathy = change mental status
spasticity is especially noted in the ___ with MS
LE
what is D-alfampridine (ampyra)?
NOT a disease modyfing therapy
increases walking speed (by 35%)
works at NMJ
neuromyelitis optica is a combo of what diseases?
transverse myelitis and optic neuritis
how does neuromyelitis optica differ from transverse myelitis?
neuromyelitis optica - >3 vertebral levels involved
what is the most aggressive type of NMO? least?
most - AQP4
least - MOG
what issue are present with vestibular disorder?
vertigo
nystagmus
what issues are present with cerebellar disorder?
vertigo
nystagmus
dysarthria
limb ataxia
unable to stand with feet together
what issues are present with sensory disorder?
limb ataxia
vibration and position sense impaired
depressed or absent ankle reflexes
can’t stand with feet together eyes closed
function of vermis
proximal limb
truncal coordination
function of lateral hemispheres of cerebellum
motor planning for extremities
appendicular movements
function of flocculonodular lobe
balance
vestibuloocular reflex
T/F: ataxia can be present with brainstem lesions
T
peduncle connect
limb/trunk/gait ataxia is ____ (ipsi/contra) to cerebellum lesion
ipsi
main clinical manifestations of cerebellar dysfunction
dysmetria
dysdiadokinesia
impaired checking
hypotonia
mutism, scanning, dysarthria
oculomotor deficit, nystagmus, abnormal saccades
what speech symptoms is characteristic of cerebellar lesions?
scanning
causes of acute ataxia
intoxication
vascular lesions: strokes
trauma
infections
causes of subacute ataxia
brain tumors
alcholic-nutritional
vit E
paraneoplastic
demyelinating causes (MS)
causes of chronic ataxia
friedreich ataxia
spinocerebellar ataxia
multisystems atrophy (Parkinson’s like)
hereditary metabolic diseases: lipid, mitochandria
rostral vermis syndrome is usually seen with
chronic alcoholics
rostral vermis syndrome sx
WBOS
axial ataxia
gait ataxia
caudal vermis syndrome is typically seen in
children with medulloblastoma
caudal vermis syndrome sx
axial dysequilibrium
staggering gait
little to no limb ataxia
spontaneous nystagmus
features of cerebellar hemispheric syndrome
incoordination/ataxia of ipsi
poor fine motor control
features of pancerebellar syndrome
bilateral cerebellar signs affecting limbs, trunk, and cranial musculature
spinocerebellar ataxias have a cerebellum that appears
small and atrophic
friedreich ataxia is a _____ disease affecting the ____, _____, ____
mutli-organ
heart, brain, nerves
Friedreich ataxia sx
loss of ambulation after 10-14 years
foot deformities
scoliosis
loss of proprioception: foot slap and toe gripping
