Lecture 15 - MS Flashcards

1
Q

4 clinical subtypes of MS:

which is most common to present with?

A

1) Relapsing-Remitting – 80% at Diagnosis
2) Primary Progressive – 10-15% at Dx

	3) Secondary Progressive - 50% of RR after 15 years 
		Gradual accumulation of disability 
		No more relapsing and remitting 

	4) Progressive relapsing -- Rare
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2
Q

basic immunology behind MS

A

hyperactive Th1 and Th17 cells; attacking myelin

not being kept in check by Treg and Th2

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3
Q

possible causes of MS

suspected chromosome?
what viruses?
what environemntal factors?

A

genetics – chromosome 6 mutatins

Viral – EBV, JC, HIV

Environemnt – Vit D def, smoking, high salt

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4
Q

what features are seen on histopathology?

what’s seen on MRI

A

extravasion of immune cells out of venule
Demyelination of axonal pathway

T2 MRI – Dawson’s fingers; lesions perpendicular to long axis of ventricles (gray matter)

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5
Q

Common initial presentations for MS

Later onset symptoms

A
Optic Nerve Inflammation
		Poor Balance (Ataxia)
		Dizziness (vertigo)
		Weakness
		Double VisionBowel bladder
		Pain
		Sensory Loss 

Fatigue, Spasticity, sexual dysfunction, cognitive

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6
Q

whats needed to make the formal dx of MS

A

2 episodes of symptoms at different time points

Meet MRI criteria –

absence of other treatable causes

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7
Q

Treatment of MS

A

Drugs – acute – Corticosteroids
Longer term – IVIG?

Nutritional – vit d, low fat, fish oils

Physical therapy

Psychosocial support

symptom management – gabapentin

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8
Q

three other demyleinating disease of this lecture?

A
  • Neuromyelitis Optica – Devic’s Disease
    • Acute Disseminated Encephalomyelitis
    • Transverse Myelitis
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9
Q

• Neuromyelitis Optica – Devic’s Disease

mutation to..?
main lesions to
Treamtnet?

A

Aquaporin 4 of astrocytes and vasculature

Optic nerve and spinal cord

treatment: acute – streoids
prophlaxis – Rituximab

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10
Q
• Acute Disseminated Encephalomyelitis
reaction to...?
inflammation of? 
treatment?
What's seen on MRI?
A

inflammation of the brain, spinal cord and, occasionally, optic nerves

  • virus, vaccine
      * Treatment: 
          * High dose steroids 
    
      MRI	• Cotton ball lesions;
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