HY from MS lecture Flashcards

1
Q

what Is Uhthoff’s phenomemon?

A

MS symtpoms that worsen during an increase in body temperature b/c of poor electrical conduction along demyelinated axons.

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2
Q

what is a relapse?

A

new neurologic disability that lasts greater than 24 hours.

may be reccurence of an old symptom: loss of vision in same eye twice, separated by an year.

maybr new symptom. weakness and numbness of both legs

SUBACUTE

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3
Q

2 lab findings consistent with MS dx?

A

IgG index and oligoclonal bands

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4
Q

neutrophils present in MS?

A

NO

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5
Q

why does gadalonium enter MS plaque?

A

b/c active inflammatio and breakdown of BBB –> allows gadolinium to enter brain parenchyma

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6
Q

bands of IgG of similar molecular weight =

A

oligoclonal bands

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7
Q

location of MS plaques?

A

periventricular and juxtacortical

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8
Q

what stain stains myelin blue?

A

luxol

demyelination shows up as white

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9
Q

MS pathogenesis?

A

genetic predisposition —> demyelination –> axonal loss

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10
Q

which type of MS more common in women?

equal in men and women?

A

relapsing remitting = MC in women

progressive = gender distribution equal

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11
Q

typical relapsing MS pt?

A

15-45 yr old woman who lives far from equator

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12
Q

describes what:

exacerbations followed by complete recovery

slow, inconsistent accumulation of disabilty

A

relapsing remitting MS

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13
Q

describes what:

develop spastic parapareis over a period of years

on exam have coritcospinal dysfunction(spasticity, weaknesss) sensory disturbance w/ urinar symptoms = long tract CNS symptoms

A

progressive forms of MS ( steady progression w/few or no exacerbations)

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14
Q

what does CSF of progressive MS pt look like?

A

just like relapsing-remitting MS, yet they never relapsed.

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15
Q

50% of MS pts need what in 15 years>

A

walking aids

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16
Q

what is found on spinal TAp of MS pt?

A

elevated Myelin basic protei nand OLIGOCLONAL banding

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17
Q

what are the four most common symptomsm that MS patients experience?

A

1. optic neuritis - unilateral, retrobulbar apin, no retinal exudates, disc hemorrhage infreqeunt, some recovery

2. myellitis (partial sensory > motor, band like pressure, Lhermmitte’s sign, bowel and bladder sx are common, acute dystonia)

3. brain stem- CN3 probs(Intranuclear opthalmoplegia and nyastagmus), trigeminal neuralgia, hemifacial spams, Bell’s palsy, vestibulopathy, and other cranial neuropathies.

**4. Cerebellar ataxia, tremor, eye movement probs **

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18
Q

MS symptoms acute or subacute?

A

subacute.

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19
Q

what leads to symptoms of MS?

A

demyelinatio nas well as axon loss

note: break down of myelin –> edema –> contribute to severity of symptoms.

20
Q

what are the 6 MC presenting symptoms of clinically definite MS pts/

A

FATIGUE!!!!!

  1. sensory symptoms in arms/legs
  2. unilateral vision loss
  3. slowly progressive motor deficit
  4. dipolopia
  5. polysymptomatic onset
21
Q

what are oligoclonal bands?

A

IgG of similar size

22
Q

oligolclonal bands also elevated in which other 2 disorders?

A

lyme disease, syphillis, lupus

23
Q

what is a visual evoked response? what is it in an MS pt?

A

meaures how log occipital cortex takes to detect retinal input

normally takes 100seconds.

in MS, optic nerve demyelinated therefore takes longer.

24
Q

what is an afferent pupillary defect consistent with in MS?

A

demeylination and axon damage on side of lesion

25
Q

what is described below:

  1. clinical episode suggestive of an MS’ pts first relapse
  2. optic nerves –> optic neuritis
  3. brainstem = internuclear opthalmoplegia
  4. spinal cord - PARTIAL transverse myelitis
  5. lasts at least 24 hours
  6. in pt that is 20-45 years old w/ no evidene of fever, infection, or encephalopathy
A

CLINICALLY ISOLATED SYNDROME

26
Q

MRI used to dx MS how?

A

MRI used to determine lesions that are disseminated in time or space

27
Q

the rule of 2’s in MRI dx of MS

A

need to have lesions that show dissemination in time (gad and non-gad lesions) and SPACE (lesions in multiple areas)

28
Q

risk of getting MS if no MRI lesion at 14 yrs?

riks of getting MS if 1+ lesion on MRI?

A

no MRI lesion - 20%

MRI lesion = 90% risk

29
Q

which two MRIs should you order in work up for MS?

A

T1 w/GAD

T2 or flair in the saggital view

30
Q

drugs used to tx MS-related symptoms?

STeroids used for ACUTE relapses

A

STEROIDS used for acute relapses, BUT NEVER BEEN shown to later natrual history of disease

-drugs like interferon-beta reduce risk of relapse, new plaque formation, and neuro progression

31
Q

t/f. never make a dx of MS by MRI alone

A

true

32
Q

MS = still a clinical dx

  • subacute onset: optic neuritis, INO, nystagmus, partial myelitis, and cerebellar syndromes.
  • focuse on pt’s complaint: vision, nyastagmus, gait
  • ask about sexual dysfunction and incontinence.
A
33
Q

what does early urinary retention suggest?

A

spinal cord lesion

34
Q

what acutely enchances with gadalonium and is limited to 1-2 vertebral bodies?

A

TRANSVERSE MYELITIS

35
Q

what is an acute neurologic condition that reflects focal inflammation of the spinal cord that acutely or subactuly develops motor, sensory, and sphincter disturbance and is usually asymmetrical with a spinal segmental level of of sensory disturbance with WELL Defined upper limit?

A

transverse MYelitis

36
Q

is spine compressed in transverse myelitis?

A

no

37
Q

t/f. Transverse myelitis may be 1st sign of MS in 30% of pts?

A

true

38
Q

how do you tx transverse myelitis?

A

IV steroids

39
Q

what is described by: severe thoracic pain, bouts of optic neuritis, acute paraparesis w/urinary retention?

A

neuromyelitis optica

40
Q

how many vertebral levels involved in neuromyelitis optica?

A

AT LEAST 3 CONTIGUOUS!

41
Q

pathology of neuromyelitis optica?

A

eosiniophils, neutrophils, hyalinized BVs (distinguishes it from MS)

42
Q

what is the mechanism of destruction of nueromyelitis optica?

A

antibody mediated demyelination, axonal injury and necrosis

43
Q

definite NMO characterized by which two diseases?

A

optic neuritis and acute myelitis

acute contigious spinal cord MRI lesin extending over >3 vertebral segments

44
Q

NMO pearls:

  1. AB mediated disease of CNS
  2. SEvere, relapsing
  3. MRI spine: T2 weighed lesions that extend contigously over 3 consecutive vertebral bodies (find acute scan)
  4. brain MRI: normal or minimal changes in MRI -lesions “atypical for MS)
  5. NMO-IgG to AQUAPORIN-4
  6. CSF: elevated WBC(>50), NEUTROPHILS OR EOSINOPHILS, NEGATIVE FOR OLIGOCLONALBANDS,

SCREEN ANY PT W/RECURRENT OPTIC NEURITIS OR MYELITIS

HICCUP IN PT W/MYELOPATHY

TX: IMMUNOSUPPRESSIVE (STEROIDS)

A
45
Q

what is described: thoracic pain/urinary problems(myelitis) + repeat optic neuritis+ acute parapareis + AB to aquaporin 4?

A

nueromyelitis optica