MS Flashcards
What process occurs during MS? Where does it primarily occur?
gliosis - change in glial cells that results in scarring which leads to axonal interruption and degeneration
white matter > gray matter
average age of onset with MS. Which gender is more likely to have MS?
15-50 years
- most common cause of disability in young and middle-aged adults
- women > men (3:1)
How is MS diagnosed?
- clinical presentation
- MRI - need to see dissemination in time (changes in plaque over time)
What are the 4 areas that gliosis needs to show up in in order to diagnosis MS
- periventricular
- juxtacortical (within the hemisphere)
- infratentorial (cerebrum)
- spinal cord
What is clinically isolated syndrome (CIS)? How long does it last
- 1st clinical episode of a disease but has yet to fulfill criteria of dissemination in time
- can be monofocal or multifocal
- lasts at least 24 hours
What 2 things occurring at the same time increase your chance of developing MS?
CIS + MRI findings
risk factors for conversion of CIS to MS
- polysymptomatic presentation
- > /= 2 T2 MRI lesions
- Oligoclonal bands present in CSF, not in serum lumbar puncture
What are the 3 common areas where CIS occurs?
- optic neuritis
- brainstem
- spinal cord
CIS signs of optic neuritis
- unilateral reduced visual acuity
- orbital pain particularly with eye movement
- reduced color vision
- afferent pupillary defect - shine light in eye and different pupil response
- retrobulbar or mild disc swelling
Think unilateral presentation
CIS signs of brainstem
- bilateral internuclear ophthalmoplegia
- ataxia and gaze-evoked nystagmus
- 6th nerve palsy
- facial sensory loss
- vertigo
- ataxia
- dysarthria
Think bilateral presentation
What is Lhermitte’s sign? When does this occur?
sharp pain that passes down posterior neck and into spine and extremities when patient flexes neck
- spinal cord CIS
CIS signs of spinal cord
- incomplete transverse myelitis
- Lhermitte’s sign
- sphincter symptoms
- asymmetric limb weakness
- symptom progression between 4 hours and 21 days
motor impairments with MS tend to be _______________
asymmetrical
MS signs and symptoms
- motor function
- sensory function
- visual deficits
- cog function
- poor tolerance for temp increases
- pain and fatigue
- sleep disorders
- speech and swallow impairments
- dizziness
- bowel and bladder dysfunction
- sexual dysfunction
MS signs and symptoms of visual deficits
optic neuritis
MS signs and symptoms of cog function
- hallmark - slowed information processing speed
- divided and sustained attention
What type of pain is common with MS
- trigeminal neuralgia
- paroxysmal limb pain - shooting pain in arms/legs
- headache
- chronic neuropathic pain
What is Uhthoff symptom?
increase in neuro symptoms in response to heating conditions
- pseudo-exacerbation that is transient (goes away once out of heat)
difference between MS exacerbations and pseudo-exacerbations
MS exacerbations last > 24 hours
pseudo-exacerbations last < 24 hours
- transient worsening of symptoms
relapsing-remitting MS
See some neurological change, followed by a period of remission (may return to baseline), then see back and forth between relapse and remission
secondary progressive MS
Start as relapsing remitting but have plateaued and little to no relapses
primary-progressive MS
continuous worsening from initial onset w/o distinct relapses
- faster progression and worse prognosis
treatment during acute exacerbation
immunosuppressant drugs to treat flare ups
- prednisone
- methylprednosolone
- Adrenocorticotropic hormone (ACTH)
Copaxone - what does it do? dosage? side effects?
- synthetic protein to mimic effects of myeline protein
- daily subcutaneous injection
side effects - flu like symptoms, N&V, joint pain, visual disturbances, weakness, edema in hands and feet
