Inflammatory/ Demyelinating Diseases (MS) Flashcards
What behavioral changes are suggested for MS pts?
- get good sleep
- exercise
- no smoking
- take vitamin D
- low salt diet
What do T1 with contrast-enhancing lesions in MS indicate?
BBB breakdown = bad short-term prognostic sign
What are the major features of Secondary Progressive MS (SPMS)?
- about 50% of RRMS converts to this MS
- changes from relapsing to only progressing
- median age is 45yo
How is MS diagnosed?
McDonald Criteria:
- multiple CNS lesions separated by space
- 2+ symptoms lasting at least 24 hours, 30 days apart for RRMS or 12 mos apart for PPMS
- abnormalities documented that can’t be explained otherwise
What causes MS?
- both genetic and environmental factors
- HLA DR2 = 3x risk
- IL-7 and IL-2 receptor alpha chain mutations
- viruses
- vitamin D deficiency
- smoking
- obesity
- high salt diet
What are the unfavorable prognostic signs in MS?
- older age at onset
- male
- African American
- high relapse rate
- short interval to 2nd relapse
- early cerebellar or motor involvement
- early disability
- high T2 lesion load on MRI
- brain atrophy
- smoker
What cells drive the pathogenesis of MS?
- abnormal T lymphocytes
- B lymphocytes
- plasma cells
- macs
How do MS lesions evolve over time?
- at first = inflammatory
- later = scar- like (sclerotic plaque)
How are acute MS attacks treated?
- high dose corticosteroids
- plasma exchange if unresponsive
Where in the CNS do MS lesions frequently occur?
in BOTH the brain and spinal cord
_____ is likely the most important prognostic MRI factor.
Atrophy
Dx?
- early stage of MS
- single relapse
- diagnosed via MRI
- not yet full MS but at high risk for developing it
Clinically Isolated Syndrome (CIS)
What CSF analysis findings indicate MS?
- protein usually N1
- WBC usually N1
- glucose ALWAYS normal
- increased and abnormal IgG
- increased myelin basic protein
What are the major features of primary progressive MS (PPMS)?
- about 15% of all MS pts
- no relapses, just slow progression from onset
- median age of onset = 45yo
What do T1 holes indicate in MS?
axonal damage = long term bad prognostic sign
What lab studies help diagnose MS?
- MRI w/ and w/o contrast with FLAIR
- CSF analysis
- Evoked potentials (EPs)
- optical coherence tomography (OCT)
- blood tests
What is Clinically Isolated Syndrome (CIS)?
- early stage of MS
- single relapse
- diagnosed via MRI
- not yet full MS but at high risk for developing it
What are the neuro exam findings in MS?
- asymmetric UMN/pyramidal tract signs (weakness, spasticity, Babinski sign)
- decreased visual acuity
- optic atrophy
- afferent pupillary defect
- eye movement abnormalities (nystagmus or INO)
- sensory loss cerebellar signs (ataxia, tremor, dysarthria)
- labile affect
- cognitive dysfunction
What is a meningeal nodule?
MS nodules containing B cell and plasma cells
What is MS without relapses, only slow progression?
primary progressive MS (PPMS)
Dx?
- MRI scan with MS lesions but no symptoms in pt
- large risk of evolving into MS
Radiologically Isolated Syndrome (RIS)
What causes an acute MS relapse?
- activation of peripheral T cells
- antigen presentation and surface adhesion molecule display
- activation of MMPs to produce BBB leakiness
- T cells, B cells, macs, and complement enter CNS
- cytokines released
- myelin, oligodendrocytes, and axons are damaged
What is the main goal of MS therapy?
life long brain health
What are the late symptoms of MS?
- early symptoms +:
- fatigue
- sexual dysfunction
- depression
- cognitive dysfunction
- pain
- dysphagia
- sz’s
- hearing loss
- immobility
What is Radiologically Isolated Syndrome (RIS)?
- MRI scan with MS lesions but no symptoms in pt
- large risk of evolving into MS
Which viruses might contribute to MS development?
- EBV
- HHV-6
- Chlamydia pneumoniae?
The majority of young adults are diagnosed with which type of MS?
Relapsing-Remitting MS (RRMS)
What are the early symptoms of MS?
- parestheisas
- monocular loss of vision
- gait problems
- weakness
- diplopia
- urinary dysfuncion
- consipation
What do T2 lesions indicate in MS?
pattern is specific to MS diagnosis
What are the major features of Relapsing-Remitting MS (RRMS)?
- sporatic episodes of new or worsened s/s (over 2-10 days)
- variable improvement over 1-6 months
- 85% of all pts with MS
What kind of MS changes from relapsing to a progressive course?
Secondary Progressive MS (SPMS)
