HY from MS lecture Flashcards
what Is Uhthoff’s phenomemon?
MS symtpoms that worsen during an increase in body temperature b/c of poor electrical conduction along demyelinated axons.
what is a relapse?
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
2 lab findings consistent with MS dx?
IgG index and oligoclonal bands
neutrophils present in MS?
NO
why does gadalonium enter MS plaque?
b/c active inflammatio and breakdown of BBB –> allows gadolinium to enter brain parenchyma
bands of IgG of similar molecular weight =
oligoclonal bands
location of MS plaques?
periventricular and juxtacortical
what stain stains myelin blue?
luxol
demyelination shows up as white
MS pathogenesis?
genetic predisposition —> demyelination –> axonal loss
which type of MS more common in women?
equal in men and women?
relapsing remitting = MC in women
progressive = gender distribution equal
typical relapsing MS pt?
15-45 yr old woman who lives far from equator
describes what:
exacerbations followed by complete recovery
slow, inconsistent accumulation of disabilty
relapsing remitting MS
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
progressive forms of MS ( steady progression w/few or no exacerbations)
what does CSF of progressive MS pt look like?
just like relapsing-remitting MS, yet they never relapsed.
50% of MS pts need what in 15 years>
walking aids
what is found on spinal TAp of MS pt?
elevated Myelin basic protei nand OLIGOCLONAL banding
what are the four most common symptomsm that MS patients experience?
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 **
MS symptoms acute or subacute?
subacute.
what leads to symptoms of MS?
demyelinatio nas well as axon loss
note: break down of myelin –> edema –> contribute to severity of symptoms.
what are the 6 MC presenting symptoms of clinically definite MS pts/
FATIGUE!!!!!
- sensory symptoms in arms/legs
- unilateral vision loss
- slowly progressive motor deficit
- dipolopia
- polysymptomatic onset
what are oligoclonal bands?
IgG of similar size
oligolclonal bands also elevated in which other 2 disorders?
lyme disease, syphillis, lupus
what is a visual evoked response? what is it in an MS pt?
meaures how log occipital cortex takes to detect retinal input
normally takes 100seconds.
in MS, optic nerve demyelinated therefore takes longer.
what is an afferent pupillary defect consistent with in MS?
demeylination and axon damage on side of lesion
what is described below:
- clinical episode suggestive of an MS’ pts first relapse
- optic nerves –> optic neuritis
- brainstem = internuclear opthalmoplegia
- spinal cord - PARTIAL transverse myelitis
- lasts at least 24 hours
- in pt that is 20-45 years old w/ no evidene of fever, infection, or encephalopathy
CLINICALLY ISOLATED SYNDROME
MRI used to dx MS how?
MRI used to determine lesions that are disseminated in time or space
the rule of 2’s in MRI dx of MS
need to have lesions that show dissemination in time (gad and non-gad lesions) and SPACE (lesions in multiple areas)
risk of getting MS if no MRI lesion at 14 yrs?
riks of getting MS if 1+ lesion on MRI?
no MRI lesion - 20%
MRI lesion = 90% risk
which two MRIs should you order in work up for MS?
T1 w/GAD
T2 or flair in the saggital view
drugs used to tx MS-related symptoms?
STeroids used for ACUTE relapses
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
t/f. never make a dx of MS by MRI alone
true
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.
what does early urinary retention suggest?
spinal cord lesion
what acutely enchances with gadalonium and is limited to 1-2 vertebral bodies?
TRANSVERSE MYELITIS
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?
transverse MYelitis
is spine compressed in transverse myelitis?
no
t/f. Transverse myelitis may be 1st sign of MS in 30% of pts?
true
how do you tx transverse myelitis?
IV steroids
what is described by: severe thoracic pain, bouts of optic neuritis, acute paraparesis w/urinary retention?
neuromyelitis optica
how many vertebral levels involved in neuromyelitis optica?
AT LEAST 3 CONTIGUOUS!
pathology of neuromyelitis optica?
eosiniophils, neutrophils, hyalinized BVs (distinguishes it from MS)
what is the mechanism of destruction of nueromyelitis optica?
antibody mediated demyelination, axonal injury and necrosis
definite NMO characterized by which two diseases?
optic neuritis and acute myelitis
acute contigious spinal cord MRI lesin extending over >3 vertebral segments
NMO pearls:
- AB mediated disease of CNS
- SEvere, relapsing
- MRI spine: T2 weighed lesions that extend contigously over 3 consecutive vertebral bodies (find acute scan)
- brain MRI: normal or minimal changes in MRI -lesions “atypical for MS)
- NMO-IgG to AQUAPORIN-4
- 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)
what is described: thoracic pain/urinary problems(myelitis) + repeat optic neuritis+ acute parapareis + AB to aquaporin 4?
nueromyelitis optica
