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3 NERVOUS SYSTEM > INFLAMMATORY DEMYELINATING DISORDERS > Flashcards

INFLAMMATORY DEMYELINATING DISORDERS Flashcards

1
Q

MYELIN IN CNS is Formed by

MYELIN in PNS is FORMED BY

A

⭐ OLIGODENDROCYTES

⭐ SCHWANN CELLS

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2
Q

Junction of MYELIN sheath of CNS and PNS is known as

A

OBERSTEINER-REDLICH ZONE

Junction of CNS and PNS

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3
Q

T ➕ B cell disorders
➕
Subacute to Chronic
➕
Autoimmune; ♀️ > ♂️
➕
OLIGODENDROCYTES and ASTROCYTES affected

A

INFLAMMATORY DEMYELINATING DISORDERS of CNS

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4
Q

DISRUPTION OF BLOOD BRAIN BARRIER by VEGF is seen in

A

INFLAMMATORY DEMYELINATING DISORDERS of CNS

VEGF A is produced by ASTROCYTES
⬇️
Injury to ENDOTHELIAL CELLS

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5
Q

ANTIBODY in INFLAMMATORY DEMYELINATING DISORDERS of CNS

A

anti-MOGP
(Myelin OLIGODENDROCYTE Glycoprotein)

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6
Q

INFLAMMATORY DEMYELINATING DISORDERS of CNS

A
  1. Multiple Sclerosis
  2. Neuromyelitis Optics Spectrum disorders
  3. ADEM : Acute Disseminated Encephalomyelitis
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7
Q

Diseases MIMICING: INFLAMMATORY DEMYELINATING DISORDERS of CNS
🧠⚡ S²CG⚡

A
  1. SLE
  2. Sarcoidosis
  3. Chronic GVHD
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8
Q

NON-INFLAMMATORY DEMYELINATING DISORDERS of CNS

A

Osmotic DEMYELINATION Syndrome
Central Pontine Myelinosis

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9
Q

CHARCOT’S TRIAD Seen in

⭐ NEUROLOGY 🧠⚡ SIN⚡
⭐ BILIARY 🧠⚡intermittent FJP ⚡

A

CHARCOT’S TRIAD OF MULTIPLE SCLEROSIS

S-staccato speech
I-intentional tremors
N-nystagmus

CHARCOT’S TRIAD in ACUTE CHOLANGITIS

✨ Fever
✨ Jaundice
✨ Pain

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10
Q

Chronic/ Subacute (3-4 wks)
➕
♀️, Young 20-40 yrs
➕
PAINFUL VISUAL LOSS
➕
Sensory > > Motor
➕
Paresthesia / Hypoesthesia / Unpleasant SENSATION

A

Multiple Sclerosis

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11
Q

Symptoms that Rule out MS
🧠⚡ DUNES HR⚡

A
  1. 8th Cranial Nerve Involvement ➡️ Deafness
  2. Peripheral Neuropathy
  3. Uveitis, Sclera Involvement
  4. Retinal involvement
  5. Severe HIGHER Mental Function Involved
  6. Encephalopathy
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12
Q

Multiple Sclerosis involves

A
  1. Cortical
  2. Subcortical
  3. Brainstem
  4. Spinal Cord
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13
Q

Pathology in MS

A

DEMYELINATION
⬇️
AXONAL ATROPHY
⬇️
NEURONAL LOSS
⬇️
CORTICAL ATROPHY

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14
Q

Most important target in MULTIPLE SCLEROSIS

A

⭐ Myelin BASIC Protein: attacked by T cells

✨ Myelin OLIGODENDROCYTE Glycoprotein MOGP : Attacked by antibody

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15
Q

HLA Association of MS

A

HLA DR-B1 15:O1
HLA DR2

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16
Q

Types of MS

A
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17
Q

⚡⚡ MOST COMMON TYPE OF MS

A

Relapsing-Remitting

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18
Q

EYE INVOLVEMENT IN MS

A
  1. OPTIC NEURITIS: U/L, ASYMMETRICAL, PAINFUL, RETROBULBAR PAIN, ANTERIOR VISUAL FIELD AFFECTED
  2. PENDULAR NYSTAGMUS
  3. B/L INO ➕ B/L TRIGEMINAL NEURALGIA
  4. PSEUDO-BULBAR INVOLVEMENT
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19
Q

✨ U/L ASYMMETRICAL, PAINFUL VISUAL LOSS, RETROBULBAR PAIN ➕, ANTERIOR VISUAL FIELD AFFECTED ➕ BETTER RESPONSIVE TO Tx

✨ B/L SYMMETRICAL, PAINLESS VISUAL LOSS, POSTERIOR VISUAL FIELD AFFECTED ➕ LESS RESPONSIVE

A

⭐ MS

⭐ NMO

20
Q

Causes of OPTIC NEURITIS

A
21
Q

🧑🏻‍⚕️ Clinical Features of OPTIC NEURITIS

A
22
Q

History of PERSISTANCE OF AFTER IMAGE Characteristic feature of

A

RETROBULBAR NEURITIS
ASSOCIATED with MULTIPLE SCLEROSIS, NMO

23
Q

Typical vs Atypical Optic Neuritis

A

Typical ON : DUE TO: DEMYELINATING DISORDERS

Atypical ON: DUE TO: other causes

24
Q

Which type of OPTIC NEURITIS is NOT ASSOCIATED WITH MULTIPLE SCLEROSIS

A

Neuro-Retinitis

25
Q

Paroxysmal Convergence Spasm Phenomenon

A

Typical but RARE symptom of MS
CAUSED DUE TO: abnormal excitation in DEMYELINATED PLAQUES

26
Q

McDonald’s Criteria used for

A

Multiple Sclerosis

27
Q

McDonald’s Criteria

A

Dissemination in TIME: 2 Clinical/Radiological Attacks, 1 month apart

Dissemination in SPACE: Involvement of 2 Site, 2 attacks = MS

28
Q

Lesion Site of MS

A
  1. Juxtacortical / Cortical
  2. Peri ventricular
  3. Brainstem
  4. Spinal Cord
  5. Infra tentorial
  6. Cerebellar
29
Q

Gold STANDARD TEST FOR MS

A

IEF(Isoelectric focussing) and Immunofixation (IgG)

30
Q

CSF Finding in MS

A
  1. IgG ⬆️ > 90 %
  2. IgG Oligoclonal Bands
31
Q

Peri ventricular lesion

A

MS

32
Q

💊💉 MANAGEMENT of ACUTE ATTACK of MS

A

High DOSE IV Methyl Prednisolone
(500mg-1mg for 3 continuous days)
No tapering

33
Q

💊PREVENTION OF ATTACKS OF MS
🧠⚡ ANTI-FOG⚡

A

Disease modifing therapies ➕ Steroids

✨ Injectable
IFN beta, Glatiramer acetate

✨ Infusibles
Natalizumab, Alemtuzumab

✨ Oral drugs
Fingolimod, Teriflunomide

34
Q

Natalizumab is Monoclonal Antibody against

A

Alpha 4 Integrin
USE: MS

35
Q

ALEMTUZUMAB is Monoclonal Antibody against

A

anti CD 52
USE: MS

36
Q

Most preferred DRUG in Remission management in MS

A

Teriflunomide

37
Q

Ocrelizumab is Monoclonal Antibody against

A

CD20

USE: Primary Progressive MS

38
Q

ONLY DRUG used for PRIMARY PROGRESSIVE MS

A

Ocrelizumab

39
Q

Acute ATTACK of MYELITIS (Long Segment Lesion)
➕
OPTIC NEURITIS PAINLESS
➕
Disabling disease with NORMAL MRI

A

NMO

40
Q

Autoantibodies seen in NMO

A

Anti-Aquaporin 4

41
Q

💊💉 MANAGEMENT of NMO

A

Steroids ➕ PLASMA EXCHANGE

Poor Prognosis

42
Q

Anti-MOG antibodies SPECTRUM
(Myelin OLIGODENDROCYTE Glycoprotein)

A
  1. ADEM
  2. ISOLATED OPTIC NEURITIS (INCLUDING CRION)
  3. Aquaporin 4 antibody negative NMO
  4. ISOLATED MYELITIS
43
Q

POST-INFECTIOUS/ POST-IMMUNIZATION
➕
CHILD
➕
ENCEPHALOMYELITIS (Altered Sensorium)
➕
Quadriplegia

A

ADEM

44
Q

DIAGNOSTIC FEATURES OF ADEM on MRI

A

Fluffy White Matter Hyperintensities

45
Q

💊💉 BEST MANAGEMENT of ADEM

A

IVIG

46
Q

SPEED OF CONDUCTION OF NERVE IMPULSE

⭐ With MYELIN

⭐ Without MYELIN

A

⭐ 70 mm/sec

⭐ 1 mm/sec

3 NERVOUS SYSTEM (40 decks)

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