MS

Question 1

What is MS gen char

Answer 1

Def: autoimmune disorder that destroys myelin in CNS
W>M
MC neurologic disability in young adults
Cause:
- autoimmune attack against myelin
- T-helper cells activate in periphery and cross BBB causing inflammation and damage (scaring) of myelin producing cytokines

Question 2

What is MS clin

Answer 2

SS: 
- lesions in CNS white matter
Primary
- direct consequence of conduction disturbances
Secondary
- complications from primary symptoms
Tertiary
- effect on pts everyday life

Dgx:
-Lesions in 2 of the following:
supratentorial
infratentorial
cervical spine
thoracic spine
- Attacks separated by Time and Space
- immunoglobulin concentrations increase CSF
- plaques in white matter
- IgG index
- Oligoclonal Immunoglobulin bands in CSF
- Proteins levels raised
- Evoked potentials

Eval:
- MRI w and w/out contrast

Txt:
symptomatic
- acute attacks
- prevention of relapses

Question 3

MS’s Chronic Cerebrospinal Venous Insufficieny Theory

Answer 3

blood drain is slowed in pts with MS

brain reflux back into brain setting off inflammation and immune-mediated damage

Question 4

What are primary signs of MS

Answer 4

eye
sensory
motor
cerebellar (balance)
other

Question 5

What are eye findings in MS

Answer 5

blurred vision
change color perception
visual field defect (optic neruitis)
optic disc pallor, atrophy
diplopia, nystagmus, oscillopsia

Question 6

What are sensory findings in MS

Answer 6

Lhermitte’s sign - electrical sensation up and down spine
Dysesthetic pain
Paresthesia
Numbness
Dorsal column signs - vibratory sense and proprioception (+ Romberg’s test)

Question 7

What are motor findings in MS

Answer 7

weakness
dysarthria
Pathologic reflexes
Corticospinal tract Hoffman’s sign

Question 8

What are cerebellar findings in MS

Answer 8

Dysdiadochokinesia
cerebellar ataxia
scanning speech
loss of balance

Question 9

what are other findings in MS

Answer 9

urinary abnormalities
cognitive and emotional abnormalities
fatigue
sexual dysfunction

Question 10

What is Lhermitte’s sign in MS

Answer 10

flick distal end of finger and it will curl up

Question 11

What is important with MRI for MS

Answer 11

• T2 (weighted image)

Question 12

Relapsing/Remitting MS

Answer 12

discrete attaches that evolve over days to weeks

usually complete recovery back to baseline

Question 13

Secondary Progressive MS

Answer 13

Begins as RRMS

steady deterioration where between acute attacks the pt does not return to baseline

Question 14

Primary Progressive MS

Answer 14

no attacks but steady decline from disease onset

Question 15

Progressive/Relapsing MS

Answer 15

occasional attacks

steady deterioration from onset

Question 16

Clinically isolated syndrome

Answer 16

one episode of neurologic damage similar to MS

Question 17

Favorable prognosis in MS

Answer 17

onset <40
F
Initial symptom - optic neuritis or sensory
low # attacks
relapsing/remitting MS