Extra 3 Flashcards
main cell in MS
oligodendrocytes
with bias to TH1 and TH17 cells
also microglial activation
upreg adhesion molecules blood vessels
MOA natalizumab
monoclonal Ab against alpha4beta integrin which means cells cannot migrate into CNS
Best preg drug MS
glatiramir
Fingolimod works how
S1p receptor modulator- keeps lymphocytes in lymphoid organs
First tab in Au
LFTs, macular oedema, bradycardia transient, increase BP small
Glatiramir works how?
alter macrophage function by being a synthetic polypeptide with myelin basic protein
Teriflunomide works how?
stop lymph prolif by stopping pyrimidine synthesis
precursor leflunomide
cholestyramine wash out pre preg
what med alters walking speed in MS
Fampridine - axons better at transmitting even in demyelinated state
Fatigue in MS give
amantadine
neuropathic pain in MS
carbamazepine
spasticity in MS
PT and OT
baclofen but increases weakness
Recap of risks after CIS
- optic myelitis
- CIS
- transverse myelitis
CIS:
1 MRI lesion only- 20%
2 MRI lesions- 80%
Transverse myelitis
no MRI brain lesion- 10-30%
MRI brain lesion- 60-90%
Optic myelitis
no MRI lesion- 25%
1 MRI lesion- 50%
3 or more- 80%
How is somatostatin def related to chronic gastritis
H pylori–>chronic gastritis–>D cells do not release
diabetes
gallstones
diarrhoea from malabsorption
What does thrombolysis achieve?
Better disability scores
Increase death first week but not at 3 months
increase risk ICH
benefit not as good if NIHSS over 25- still some benefit but higher risk haemorrhage
Verdict out if NIHSS under 4
clot retrieval increase days at home and percent good outcome
how long to wait to start warf post stroke
14 days
aspirin within 48 hours though
poor prognostic factors after ICH
GCS 3-4 Age over 80, vol over 30mL, infratent extension high BGL early neuro deterioration on warf
5 types of lacunar- locations
Pure motor- post limb IC
ataxic hemiparesis- mostly LEG>ARM- PLIC or basalis pontis or corona radiata
Dysarthria/clumsy hand syndrome- hand weak and clumsy with dysarthria; PONS
Pure sensory; thalamus
Mixed sensorimtor; thalamus or adjacent to PLIC
Most common stroke type
large vessel to large vessel
when can you give aspirin post thrombolysis?
after 24 hours
also target BP 185/95 post thromb
contraind in first place if over 185/110
Acute MS lesion GAD enhances up to …
3 months
if still enhancing at 6 months it is a tumour!
