Lecture 7: Multiple Sclerosis Flashcards
A disorder of the brain and spinal cord characterized by a tendency for periods of increasing and decreasing symptoms and signs (exacerbation and remissions), which result from loss of myelin at multiple sites in the CNS, defines what?
MS
What are 7 common symptoms of patients with MS?
1) Paresthesias
2) Gait disturbances (i.e., transverse myelitis)
3) Weakness
4) Visual loss (i.e., optic neuritis)
5) Urinary difficulty
6) Dysarthria
7) Hemiparesis
What are the 4 major types of MS?
- Relapsing remitting
- Secondary progressvie
- Primary progressive
- Benign
MS patients with the seconary progressive form of the disease begin their disease process as which form?
Relapsing remitting
Which test can confirm the diagnosis of MS?
No single test can confirm the diagnosis of MS
How does age of onset affect the prognosis of MS?
In general, earlier onset is a more favorable prognostic feature
*However, if really young (i.e., adolescent/early adult) = unfavorable
What are the typical diagnostic features seen with an MRI of the head and CT of the spine in a patient with MS?
- Ovoid lesions of high signal on T2WI in periventricular white matter and spinal cord
- Acute lesions may enhance
CSF analysis via lumbar puncture will have what diagnostic findings in a patient with MS?
Presence of oligoclonal bands and/or increased IgG index/synthesis rate
Which drug is the only approved treatment for patients with the primary progressive form of MS (PPMS) in addition to the relapsing forms of the disease?
Ocrevus (ocrelizumab)
Which 2 drugs can be given to treat acute exacerbation in MS?
Why is each drug used?
1) High dose corticosteroids: reduces length of exacerbation, but not the overall outcome
2) ACTH (acthar gel) or IVIg used in pt’s who do not tolerate traditional steroid tx.
In terms of clinically isolated syndrome (CIS) what is a monofocal episode as a differential diagnosis for MS?
Person experiences a single neurologic sign or symptom that’s causes by a single lesion (i.e., optic neuritis in one eye)
In terms of clinically isolated syndrome (CIS) what is a multifocal episode as a differential diagnosis for MS?
AKA?
- aka Acute Disseminated Encephalomyelitis (ADEM)
- Person experiences more than one sign or symptom caused by lesions in more than one place (i.e., optic neuritis in one eye plus hemiparesis)
When CIS patients have multiple demyelinating lesions on MRI, they have a __________% chance of developing MS within several years
60-80%
*High risk
When CIS patients do not have multiple demyelinating lesions on MRI, they have a ______% chance of developing MS within several years
20%
*Low risk
What are some conditions which can mimic MS?
- Autoimmune disease: SLE w/ cerebritis or CNS vasculitis or Polyarteritis Nodosa w/ transverse myelitis
- Devic’s disease (neuromyelitis optica)
- B12 deficiency
- Lymphoma or leukemia w/ CNS involvement
- Spinocerebellar ataxias
- Infections: HIV, West Nile, HTLV-1, CMV, Lyme disease, Syphillis
- Granulomatous disease
- Metachromatic leukodystrophy, adrenomyeloleukodystrophy
