Exam 4 MS

Question 1

Multiple Sclerosis is?

Answer 1

Autoimmune dz w/ genetic component ->
Slow demyelination of CNS affecting brain, spinal cord, optic nerve

Most C neuro disability in early/mid adulthood (except trauma)

Question 2

MS pathophys?

Most affected areas?

Answer 2

Attack of nerve fiber myelin sheath ->
Causes plaques of demyelination

• White matter of cervical and dorsal regions of lateral and posterior columns of brain stem
• Optic nerve and periventricular area in brain

Question 3

MS “Key Feature”?

Answer 3

CNS white matter lesions separated by time and space

Question 4

MS presentation?

Answer 4

U white female, Ave onset 30 yo
Insidious, waxing/waning
Visual ∆s
Dizziness
Paresthesia extrem, trunk, unilat face
↓ coordination
Dysdiadochokinesia (↓ rapid alternating mvmt)
Pain
↓ Bowel/bladder control
↓ Cognition

Question 5

MS exam findings: Internuclear ophthalmoplegia?

Answer 5

Medial rectus weakness when CN III and IV involved in mvmt:
Eye can’t turn in to look at nose on one side (conjugate gaze)
e.g. right eye looks right, left eye stay looking straight

However, both eyes will converge (both look medially) because signal only involves CN III

Question 6

MS exam findings: Lhermitte’s Symptom?

Answer 6

Neck flexion causes electrical shock down back and legs

Question 7

MS exam findings: Optic neuritis? (3)

Answer 7

↓ acuity
Papilledema
Marcus Gunn Pupil

Question 8

Marcus Gunn Pupil

Answer 8

Affected pupil consensually responds to good eye:
Pupil contracts to indirect light normally, but dilates to direct light
(follows lead of opposite eye that is now dilated in absence of direct light)

Question 9

MS exam findings: Pyramidal tract involvement? (5)

Answer 9

(UMN sxs)
Hyper-reflex
Clonus
No abdominal reflexes
\+ Babinski (Big toe extends, others fan out)
Limb weakness

Question 10

MS exam findings: Cerebellar involvement? (4)

Answer 10

Nystagmus
Incoord
Dysarthria (unclear speech)
Ataxia

Question 11

MS exam findings: Posterior column invovement? (3)

Answer 11

↓ vibration
↓ proprioception
Lhermitte’s

Question 12

Relapsing/Remitting MS presentation?

Answer 12

Sxs develop over 1-2 wks,
Resolve in 4-8 wks
Most begin w/ this pattern

Question 13

Secondary progressive MS presentation?

Answer 13

Starts as Relapse/Remit

~ 5 yrs becomes Relapse/Progressive

Question 14

Primary progressive MS presentation?

Answer 14

Gradual progression from onset

Most C w/ onset > 40 yo

Question 15

MS CSF findings? (3)

Answer 15

P > 5 mononuclear cells
↑ IgG
Oligoclonal bands

Question 16

MS imaging?

Answer 16

MRI best test: Bright signal plaques

Evoked Potential test: measures time for stim to eye, ear or periphery to reach cerebral cortex

Question 17

MS DDX? (5)

Answer 17

↓ B12, Vit E
Thyroid/Adrenal dzs
Collagen vascular dz (RA, SLE, etc)
Syphilis, HIV
Inherited ataxias

Question 18

MS tx?

Answer 18

No cure

Acute attack: high-dose steroids

Chronic:
Alpha4 agonist (natalizumab) reduces brain lesions
Interferon β1 + glatiramer (myelin protein)
P immunosupp

Question 19

MS sxs tx:

Spasticity?

Ataxia?

Incontinence?

Sex dysfxn?

Pain?

Fatigue?

Answer 19

Spasticity = mm relax/anti-spast

Ataxia = none effective

Incontinence = anticholinergic

Sex dysfxn = Viagra

Pain = Baclofen, clonazepam, gabapentin

Fatigue = amantadine, ritalin