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Neuro 2 > MS > Flashcards

MS Flashcards

1
Q

MS patho phys

A

Abnormal immuno-mediated response attacks myelin, oligodendrocytes, and the axons

Activation of immune cells that cross BBB, enter CNS

Acute inflammatory attack gradually subsides (REMISSION), remyelination occurs
Remyelination often incomplete

With time, anti-inflammatory responses/remyelination cannot keep up
Demyelinated areas undergo gliosis
White matter > gray matter

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2
Q

avg age of onset MS

A

15-50 yrs

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3
Q

predisposing factors MS

A

wome>men
caucasion
exposure to epstien barr virus

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4
Q

diagnosis
2 criteria

A

MRI gold standard
dissemination in space
dissemination in time

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5
Q

dissemination in space areas

A

preventricular
juxtacortical
infratentorial
spinal cord

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6
Q

early detection in MS has been shown to

A

significantly decline number of attacks lesion sites and disability

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7
Q

CIS what is it

A

First clinical episode of a disease that shows characteristics of inflammatory demyelination that could be MS but has yet to fulfill criteria of dissemination in time

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8
Q

most commonly affected areas in CIS

A

brainstem spinal cord optic nerve

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9
Q

risk factors for conversion to clinically definite MS

A

Polysymptomatic presentation
>2 T2 MRI lesions
Oligoclonal bands present in CSF, not in serum

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10
Q

CIS + MRI
CIS w/o MRI

A

60-80 to develop

20 to develop

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11
Q

CIS optic neuritis s/s

A

Unilateral reduced visual acuity
Orbital pain particularly with eye movement
Reduced color vision
Afferent pupillary defect
Retrobulbar or mild disc swelling

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12
Q

cis brainstem s/s

A

BL opthalmoplegia
Ataxia and gaze evoked nystagmus
6th nerve palsy
Multi-focal symptoms
Facial sensory loss
Vertigo
Ataxia
Dysarthria

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13
Q

spinal cord s/s cis

A

Spinal cord
Incomplete transverse myelitis
Positive Lhermitte’s sign
Sharp nerve pain (often described as an electric shock) that passes down posterior neck and into spine & extremities when patient flexes neck
Sphincter symptoms
Asymmetric limb weakness
Symptom progression between 4 hours and 21 days.

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14
Q

MS clinical s/s

A

motor
sensory
visual
cog
poor tolerance for temp
fatigue
pain
sleep disorders
B/b dysfx
sexual dys fx

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15
Q

ms cog hallmark

A

Hallmark: slowed information processing speed

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16
Q

pain ms s/s

A

Trigeminal Neuralgia
Paroxysmal limb pain
Headache
Chronic neuropathic pain

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17
Q

heat insensitivity MS

A

Uhthoff symptom
Increase in presence of neurological symptoms in response to heating condition
Pseudo-exacerbation

Neuroblockade hypothesis: de-myelinated neurons ability to conduct APs decreases as temperature increases

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18
Q

ms and fatigue

A

Tends to worsen as day progresses
Exacerbated by heat, exercises

19
Q

ms and fatigue can often lead to

A

to fear of fatigue  decreased physical activity  disuse  worsening disability

20
Q

exacerbations ms

A

MS Exacerbation: new and recurrent MS symptoms lasting >24 hours

Idiopathic vs Exacerbating factors:
Viral or bacterial infections
Disease
Major or minor stressors

21
Q

psudoexacerbations ms

A

Transient worsening of symptoms
Occurs due to stress, infection, overheating, or overexertion

22
Q

RRMS

A

Clearly defined episodes of acute worsening of neurologic function (relapses), followed by partial or complete recovery (remissions) with periods of time between that patients are clinical free of disease progression

Relapses with either full recovery or some remaining neurological signs/symptoms

23
Q

SPMS

A

Initially presents as RR period followed by a steady worsening of neurologic function, with or without relapses

Remissions are minor, or can have plateau

24
Q

PPMS

A

Continuous worsening from initial onset without distinct relapses or remissions

May have occasional plateaus and temporary minor improvements

25
Q

acute exacerbation tx

A

Immunosuppressant drugs: treat acute flare ups and shorten duration of episode
Prednisone
Methylprednisolone
Adrenocorticotropic hormone (ACTH)

26
Q

disease modifying drugs

A

interferon
copaxone

27
Q

interferon

A

IM or SC injections
daily 3xwk or weekly
slow prog of disease/s/s
AE - flu like leukopenia

28
Q

copaxone

A

Daily subcutaneous injection
Synthetic protein designed to mimic effects of myelin protein
Side effects: flu-like symptoms, nausea, visual disturbances, edema in hands and feet

29
Q

pain ms management meds

A

neurotin

30
Q

urinary dysfunciton meds

A

anticholinergic

31
Q

EDSS 8 systems

A

pyramidal - plegia
cerebellar
brainstem
sensory
b/b
visual
cerebral
other

32
Q

disability categorization EDSS

A

0-3.5 norm to mild
4-5.5 mild to mod
6-7.5 mod to severe
8-9.5 severe disability bed or wheelchair bound

33
Q

disease steps scale can only be used for ms until

A

they are in a wheelchair and then no further

34
Q

12 item MS walking scale
EDSS level
cut off

A

0-7.5
>=75 fall risk

35
Q

mean time before use of unilat AD ms

A

15-20yrs

36
Q

life expectancy in ms

A

10 yr less

37
Q

average yrs spent at each level

A

about 3

38
Q

disease prognosis if they have white matter lesions on MRI

A

88 percent of developing MS

39
Q

appearance of ____ = poor prog ms

A

new lesions on T2 weighted MRI in < 2mo

40
Q

good prognosis MRI ms

A

low total lesion burden, low active lesion formation, and negligible myelin or axon loss

41
Q

disease prognosis clinical

A

RRMS vs PPMS
# of CNS systems involved
age
neuro findings at 5yrs

42
Q

Tx EDSS 0-2.5

A

min mob def
standard test might not be sensitive enough
assessment of pt when symptomatic is extremely helpful
focus on edu and max fit levels

43
Q

EDSS 3-6 tx

A

impairments more apparent
may begin to impact activity
secondary impairments develop

Treatment considerations:
Intermittent versus continuous activity
Can improve tolerance by increasing rest periods

44
Q

6.5-9.5 EDSS tx

A

Significant mobility and functional limitations
More pronounced comorbidities
Longer remission periods

Treatment considerations
Despite focus being largely compensatory and preventative, it can still be very meaningful!
Major goal is to improve safety and efficiency with mobility

Neuro 2 (9 decks)

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