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Neuro > MS > Flashcards

MS Flashcards

1
Q

what kind of disease is MS

A

Autoimmune demyelinating disorder affecting the CNS

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2
Q

what is Charcot’s triad of MS

A

Nystagmus, intention tremor and scanning speech

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3
Q

who is mostly likely to get MS

A

females 20-50 y/o of northern european descent

risks seem to increase with distance from the equator

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4
Q

what are the suspected environmental triggers for MS

A

viral exposure (EBV, canine distemper virus)
tobacco exposure
lack of exposure to infectious agents early in life

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5
Q

what viruses are possibly protective against MS

A

CMV, HSV, HIV

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6
Q

what is the pathogenesis of MS thought to be

A

ACP present a signal and active T-cells in the lymph node.
Activated T-cells enter the peripheral blood stream to find their target in the CNS.
T-cells attach to, break down and cross the BBB.
secrete pro-inflammatory cytokines leading to myelin destruction and neuronal death

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7
Q

how do the T-cells enter the CNS

A

release of IL’s that cause an inflammatory response to disrupt the BBB

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8
Q

describe the effects of MS on the axons

A

demyelination leads to garbled signals being sent via the nerves - over time the myelin may regenerate or axonal damage may occur

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9
Q

what is the clinical characteristics of MS

A

clinical relapses with new neurological symptoms lasting > 24 hours due to CNS demyelination followed by remission
usually 1-2 attacks per year

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10
Q

what is optic neuritis

A

decreased monocular vision (often involving central vision)
pain with eye movement
decreased red/green color

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11
Q

what other ocular problem is optic neuritis associated with

A

Afferent pupillary defect (APD or Marcus-Gunn pupil)

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12
Q

what is the Uhthoff phenomeon

A

optic neuritis in MS gets worse with heat - used to test by having the pt sit in a hot tube

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13
Q

how is an afferent pupillary defect tested

A

shine a light in the affected eye and neither eye constricts but shine a light in the other eye and both will constrict

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14
Q

how do lesion in MS differ from a stroke

A

stokes usually affect deep areas of the brain first (where there is less blood supply)
MS lesions tend to be near the periphery of structures where there is greater blood supply

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15
Q

what are 6 brainstem syndromes that are highly suggestive of MS

A 
Internuclear ophthalmoplegia
Oculomotor dysfunction
Ataxia
Trigeminal Neuralgia
Facial nerve palsy
CST/upper motor neuron involvement
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16
Q

what is Internuclear ophthalmoplegia and where is the lesion likely

A

when one eye is unable to adduct when looking laterally but is able to accommodate for close objects

likely a lesion near the CN 6 nucleus

17
Q

what is Lhermitte’s sign

A

electric shock sensation with the neck flexed

18
Q

what does a sensory level indicate

A

spinal cord lesion

19
Q

what are some symptoms that can help distinguish MS from GBS

A

sensory level

urinary urgency, incontinence, ED

20
Q

what does a Romberg sign indicated

A

loss of proprioceptive control (does not localize to the central or peripheral NS)

21
Q

how is MS diagnosed

A
  • objective demonstration of a CNS white matter lesion based on clinical or radiographic grounds that are separated in time and space (and there is no other better diagnosis)
22
Q

what are the typical locations for a MS lesion

A

Juxtacortical, periventricular, infratentorial, spinal cord

23
Q

what are some characteristics of a typical MS lesion

A

Lesions >3mm
Corpus callosum lesions
Optic radiation lesions
Brainstem lesion abutting the 4th ventricle or aqueduct
Incomplete/partial enhancement
T1 “Black Holes”- atrophy from chronic damge

24
Q

describe Dawson’s fingers

A

perpendicular oriented periventricular lesions - seen in a saggital flair scan - only seen in MS

25
Q

where are spinal cord lesions usually located in MS

A

Located in the cord periphery, especially the dorsal columns

- Lesions begin at the pial surface

26
Q

how big are the spinal cord lesions typically

A

small

27
Q

what is another test you could do for MS if the MRI is not clear

A

Lumbar puncture and look at the CSF

28
Q

what would the CSF show in MS

A

normal protein, glucose, and cells counts usually

w/ Oligioclonal bands and possibly IgG abnormalities (elevated intrathecal IgG synthesis)

29
Q

what do oligioclonal bands in the CSF indicate

A
  • Provides evidence for intrathecal synthesis and carries the implication of immunological process in the CNS
  • Once present are persistent
  • OCBs with optic neuritis or first event (CIS) is associated with an increased risk of MS
30
Q

what are 3 other disease processes that should be on your differential when considering MS (classic MS mimics)

A

Neuromyelitis Optic and acute disseminated encephalomyelitis

31
Q

what is neuromyelitis optica

A
  • Longitudinally extensive spinal cord lesion (>3 vertebral segments)
  • Bilateral optic neuritis
  • Hic-coughs
  • Normal/minimal brain lesions
  • NMO IgG Ab positive (also autoimmune but with Ab for a aquaporin)
32
Q

what is acute disseminated encephalomyelitis (ADEM)

A
  • Often post-infectious process
  • Commonly present w/ HA, vomiting, drowsiness and meningism (often initially treated for infectious meningoencephalitis)
  • Large, “fluffy” multifocal lesions
  • More common in children than adults
  • one time occurance
33
Q

what is PML caused by

A

John Cunningham Virus (opportunistic infection)

34
Q

who commonly gets PML

A
  • people with HIV

- can also be a rare side effect that occurs in those taking natalizumab (MS drug) who are also JC virus positive

35
Q

whats the prognosis of PML

A

Can lead to death or severe neurologic injury; better chance of recovery with early detection

36
Q

what are the lesion like in PML

A

Multiple lesions are commonly present

Frequently subcortical hemispheric white matter or cerebellar peduncles

37
Q

how should you treat a patient with an MS relapse

A

IV methylprednisonle

Neuro (11 decks)

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