MS Flashcards
what is MS
progressive autoimmune disease characterized by inflammation, selective demyelination and gliosis
what does demyelination lesions do
impair neural transmission causes nerve fibers to fatigue rapidly
pathophys of MS
abnormal immune mediated response that attacks the myelin, oligodendrocytes and axons throughout the CNS
what happens during remission
remyelination, often incomplete
what happens with time after relapses
cant keep up
demyelinated areas undergo gliosis
average age of onset
15-50 years old
predisposing factors
women
caucasian of nordic origin
higher income countries
low vit D exposure during childhoos and teenage years
exposure to Epstein-Barr virus
how to diagnosis
clinical presentation
MRI - gold standard; lesions must be seen in 2/4 lesions
what can improve progression of the disease
early drug treatment protocols
significant decline in number of attacks, lesion sites and disability
what is clinically isolated syndrome
first clinical episode of a disease that shows characteristics of inflammatory demyelination that could be MS but hasn’t fulfilled criteria of dissemination in time
what does CIS mostly affect
optic nerves
brainstem
spinal cord
what is CIS treated with
high dose glucocorticoids for acute symptoms
risk factors for the conversion to clinically definite MS
polysymptomatic presentation
more than or equal to T2 MRI lesions
oligoclonal bands present in CSF, not in serum
CIS and MRI findings = what % of MS developing
60-80%
CIS without MRI findings = what % of MS developing
20%
CIS symptoms seen with relating to optic neuritis
unilateral reduced visual acuity
orbital pain particularly with eye movement
reduced color vision
afferent pupillary defect
retobulbar or mild disc swelling
CIS symptoms seen relating to the brainstem
bilateral internuclear opthalmoplegia
ataxis and gaze evoked nystagmus
6th nerve palsy
multi focal symptoms
facial sensory loss
vertigo
ataxia
dysarthria
CIS symptoms seen relating to the spinal cord
incomplete transverse myelitis
positive lhermitte’s sign
sphincter symptoms
asymmetric limb weakness
symptom progression btw 4 hours and 21 days
MS SxS typically seen
motor fxn
sensory fxn
visual deficits - optic neuritis
cognitive fxn
poor tolerance for temp increases
fatigue
pain
sleep disorders
speech/swallow impairments
dizzy
bowel/bladder
sexual dysfunction
what type of pain is seen in MS
trigeminal neuralgia
paroxysmal limb pain
HA
chronic neuropathic pain
MS and heat insensitivity internal triggers
vigorous exercise
high fevers
MS and heat insensitivity external triggers
environmental temp
bathing or swimming in hot water
what is the uhthoff symptom
increase in presence of neurological symptoms in response to heating condition
pseudo-exacerbation
what does the fatigue feel like for these pt’s
worsen as day progresses
exacerbated by heat, exercise
what can these fatigue symptoms lead to
fear –> decreased physical activity –> disuse –> worsening disability
MS exacerbation
new and recurrent MS symptoms lasting >24 hours
