L9: Multiple Sclerosis - Pt 1 Flashcards

1
Q

Normal anatomy & physiology

  • related to MS
A

Read From Notes

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2
Q

What are Demylinating Diseases?

A
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3
Q

Examples of Demylinating Diseases

A
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4
Q

Def of MS

A
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5
Q

Causes of MS

A
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6
Q

Pathlogy in MS

A
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7
Q

Pathlogy in MS

  • Characterestic Lesions
A
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8
Q

Pathlogy in MS

  • Sites Affected
A
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9
Q

Pathlogy in MS

  • Sites Spared
A
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10
Q
  • The BBB is disrupted at the …… of symptoms
  • Onset is not known yet whether demyelination precedes or is secondary to inflammation
A

Onset

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11
Q

Composition of BBB

A
  • The BBR is composedof endothelial cells: which line the blood vessel walls of the CNS.
  • The cells lining the BBB are connected by occludin and claudin which form tight junctions in order to create a barrier to keep out larger molecules such as proteins.
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12
Q

In Order to pass thru BBB, …..

A

In order to pass through, molecules must:

  • be taken in by transport proteins
  • alteration in the BBB permeability.
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13
Q

Pathogenesis of BBB Disruption

A
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14
Q

Pathogenesis of BBB Disruption

  • Activation of Myelin-Reactive T-cells
A
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15
Q

Pathogenesis of BBB Disruption

  • T-Cells Secrete
A
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16
Q

Pathogenesis of BBB Disruption

  • Macrophages
A

Macrophages engulf oligodendrocytes

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17
Q

Pathogenesis of BBB Disruption

  • B-Cells
A

B-cells produce antibodies against myelin

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18
Q

Pathogenesis of BBB Disruption

  • Vicious Cycle
A
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19
Q

The severity of demyelination may be assessed by ….

A

relative preservation or destruction of ligodendrogliocytes.

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20
Q

Loss of myelin results in one or all of the following:

A
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21
Q

Autoimmunity & MS

A
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22
Q

Summary of pathophysiology of MS

A
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23
Q

Summary of pathophysiology of MS

  • BBB
A
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24
Q

Summary of pathophysiology of MS

  • Auto-immunity
A
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25
Q

Summary of pathophysiology of MS

  • Inflammation
A
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26
Q

Incidence of MS

A
  • 200 people are diagnosed every week in U.S.
  • As of 2008, 2-2.5 million people worldwide are
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27
Q

Age in MS

A
  • 10 and 80 years of age
  • Usually begin Between 20 and 40
    (mean age of 32)
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28
Q

Race & Sex in MS

A
  • Women than men (2:1)
  • Caucasians more than Hispanics or African Americans, less common in Asians.
  • Increases the farther one travels from the equator in either hemisphere
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29
Q

CP of MS

A

(affect any area of the Brain, Optic nerve, or Spinal cord, causing almost any neurologic symptom)

  • Sensory
  • Motor
  • Visual
  • cerebellum
  • Neuropsychiatric
  • Genaturinary
  • Fatigue
  • Utthoff’s Sign
  • Relapse
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30
Q

CP of MS

  • Visual
A
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31
Q

CP of MS

  • Internuclear ophthalmoplegia (INO)
32
Q

CP of MS

  • Sensory
33
Q

CP of MS

  • L’hermitte’s Sign
A
  • Electrical sensations run down the spine when the patient bends her head forward due to lesion of the dorsal column of cervical cord or cauda medulla
34
Q

CP of MS

  • MS Hug
A

Tightening around the chest

35
Q

CP of MS

  • Motor
36
Q

CP of MS

  • Cerebellar
A
  • Tremors
  • Ataxia
37
Q

CP of MS

  • Neuropsychiatric
A
  • Depression
  • Irritability
  • Anxiety
  • Memory & Concentration Abnormalities
38
Q

CP of MS

  • Genaturinary
39
Q

CP of MS

  • Intractable Fatigue with no Other Causes
40
Q

CP of MS

  • Uthoff’s Phenomenon
A

Classic MS Sign

  • Worsening of symptoms in the heat (hot weather, exercise, fever)
41
Q

CP of MS

  • Relapse
42
Q

Def of Relapse in MS

A
  • Worsening of present symptoms or appearance of new symptoms
  • At least 24 h
  • 1 month from East attack
  • Not during steroid withdrawal or infection
  • Increased EDDS ≥ .5
43
Q

Symptoms Characters in Relapse in MS

A
  • Develop over a few days
  • Improve over weeks or months
  • Followed by a period of stability (a remission)
  • Stabilize for a few weeks
44
Q

The Most common initial Symptoms in MS

A
  • Changes in sensation in the arms, legs or face (33%)
  • Optic neuritis (20%)
  • Weakness (13%)
  • Double vision / internuclear
  • ophthalmoplegia (7%)
  • Unsteadiness when walking (5%)
  • Balance problems (3%)
45
Q

Classification of MS

46
Q

Classification of MS

  • PRMS
47
Q

Classification of MS

  • SPMS
48
Q

Classification of MS

  • PPMS
49
Q

Classification of MS

  • RRMS
50
Q

Def of EDSS

A
  • Method of quantifying disability in multiple sclerosis & monitoring changes in the level of disability overtime. It is widely used in the assessment of people with MS.
51
Q

EDSS is Based upon ……

52
Q

Prognosis in MS

53
Q

Prognosis in MS

  • Good
54
Q

Prognosis in MS

  • Poor
55
Q

Def of Clinically Isolated Syndome in MS

A

Individual’s first episode of neurological symptoms lasting at least 24 hours.

56
Q

Clinically Isolated Syndome in MS

  • Optic Neuritis
A
  1. Typically unilateral
  2. Retrobulbar
  3. Typically painful
  4. Some recovery expected
  5. No retinal exudates
  6. No macular star
  7. Disc hemorrhages infrequent
57
Q

Clinically Isolated Syndome in MS

  • Myelitis
A
  1. Partial sensory or motor
  2. Sensory more common
  3. L’hermitte sign
  4. Bowel and bladder dysfunction
  5. Band-like abd. or chest pressure
  6. Acute dystonias
58
Q

Clinically Isolated Syndome in MS

  • Cerebellum
A
  1. Cerebellar outflow tremor
  2. Acute ataxic syndrome
59
Q

Clinically Isolated Syndome in MS

  • Brainstem/Cerebrum
A
  1. Ocular motor syndromes (e.g. intranuclear ophthalmoparesis/ nystagmus)
  2. Hemisensory, crossed sensory syndromes
  3. Hemiparesis
  4. Hemifacial spasm
  5. Trigeminal neuralgia
60
Q

Clinically Isolated Syndome in MS

  • Paroxysmal Symptoms
A
  1. Tonic spasms
  2. Paroxysmal dysarthria/ataxia
61
Q

Dx of MS

62
Q

Dx of MS

  • Apsects
A
  • Exclude other explanations
  • Prove it is M.S diagnoses
63
Q

Dx of MS

  • Clinical
A
  • History and examination (all c/p not single symptom)
  • Evidence of CNS involvement.
  • Dissemination in space and time
64
Q

Dx of MS

  • INVx (Paraclinical)
A
  • Neuroimaging.
  • Evoked potentials.
  • CSF analysis.
65
Q

Dx Criteria of MS

66
Q

Dx of MS

  • MRI
67
Q

Dx of MS

  • Evoked Potentials
68
Q

Dx of MS

  • CSF Examination
69
Q

CSF Examination in MS

  • Sensitivity
A

Abnormal in 85% to 90% of patients with MS.

70
Q

CSF Examination in MS

  • Cells
A

Increased, specially during activity up to 40 cells/ mm3

71
Q

CSF Examination in MS

  • Total Protein
A

moderately Increased

72
Q

CSF Examination in MS

  • Gamma Globulin
A

Increased, especially IgG ( T total IgG, IgG ratio, IgG synthesis rate).

73
Q

CSF Examination in MS

  • Oligoclonal Bands
A
  • Presence of two or more oligoclonal bands in the CS that are not present in a simultaneously drawn serum sample ICS examination
74
Q

CSF Examination in MS

  • IgG Index
75
Q

Done