MS

Question 1

MS affects what part of the brain?

Answer 1

white matter and spinal cord
axons
near ventricles and optic nerve
cerebellum, brain stem, basal ganglia
*depending on what part of brain affects = sx

Question 2

MS - cx?

Answer 2

unknown

suspicions of genetics

Question 3

MS - imaging?

Answer 3

plaques (near ventricle and optic nerve)

*not diagnostic

Question 4

MS - population?

Answer 4

20-30 yo
females
caucasian
northern latitudes

Question 5

MS - sx?

Answer 5

blurred vision
numbness/tingling
balance
spasticity
bowel, bladder, sexual fxn changes
Uhthoff phenomenon 
Lhermitte's sign

Question 6

Uhthoff’s phenomenon?

Answer 6

worsening sx after exposure of some out of norm temp (bath tub)

Question 7

Lhermitte’s sign?

Answer 7

tingling down back into limbs when flexing neck

Question 8

Lesion?

Answer 8

pyramidal/cortitcospinal

Question 9

MS - classification?

Answer 9

relapsing remitting
secondary progressive
primary progressive
progressive relapsing

Question 10

Relapsing remitting?

Answer 10

episodic
never return to baseline
worse sx w/ every episode

Question 11

Secondary progressive?

Answer 11

starts off as relapsing but turns into primary progressive (never getting better/not episodic)

Question 12

Primary progressive?

Answer 12

not episodic - always getting worse

Question 13

Progressive relapsing?

Answer 13

episodic and progressively getting worse

Question 14

What is not typical of MS?

Answer 14

50 yo
cortical deficits (alexia, agraphia, apraxia, aphasia)
seizures
early dementia
rigidity (basal ganglia)

Question 15

MS - dx?

Answer 15

CIS - lasts 24 hrs d/t inflammation/demylination

nothing definitive - clinical dx (but early dx = slows progression)

Question 16

MS - PE/exams?

Answer 16

25 foot timed walk

9 hole peg (UMN)

Question 17

MS - imaging?

Answer 17

MRI (even for baseline)
b/c if plaques are found 1st around - does not tell us when plaques were there - but if f/u is done then there is a timeline (plaques along ventricles over short pd of time = most likely MS though NOT diagnostic)

Question 18

MS - CSF?

Answer 18

not needed unless MRI is not good enough
+protein, norm glucose
CSF oligoclonal banding
CSF IgG synthesis

Question 19

MS - tx?

Answer 19

nothing - DMT (Dz modifying therapy)
-does not reverse sx, resuce acute MS relapses, slow dz
acute? - HD, short corticosteroids; plasma exchange
Beta interferons (pallative) 
Vita D (doesn't hurt to give em; may reduce relapse if it works)
OT/PT (to make them more functional)

Question 20

MS - what to watch out for?

Answer 20

immunization

depression