MS

Question 1

what is MS

Answer 1

acquired d/o with immune-mediated destruction of nml CNS myelin w/ secondary loss of axons

Question 2

what is the classic lesion of MS

Answer 2

demarcated white matter plaques which are found in optic nerves, spinal cord, and brain with periventricular predominance

Question 3

cause of MS

Answer 3

• genetically susceptible pt exposed to triggering factors (viruses?) that provoke immune mediated attack against CNS myelin
• sibs have 20-fold greater risk

Question 4

Clinical features of MS

Answer 4

• onset 20-40, F2:M1
• 80% initially have relapsing-remitting course, 20% have primary progressive (doesnt respond well to immunomodulating therapy)
• neurologic deficits in secondary progressive phase of MS

Question 5

most common initial s/s of MS

Answer 5

-involve optic nerves OR sensory or motor deficits in the lower limbs (longest white matter tracts in the CNS, functionally related to lower limbs are statistically more likely to develop MS plaques)

Question 6

optic neuritis in MS

Answer 6

-partial or total loss of vision in one eye

Question 7

INO MLF

Answer 7

-may be cause of blurry vision or diplopia in MS

Question 8

Lhermittes sign

Answer 8

• electric shock or tingling sensation sown the spine into arms and legs provoked by neck flexion
• d/t short circuiting within posterior columns of cervical spinal cord d/t demyelination or inflammation from MS plaques, vit B12 deficiency, or sc compression

Question 9

MS diagnosis

Answer 9

• multiple s/s disseminated in time and space sans a better explanation
• MRI of brain and sc have great sn (less sp) in detecting small white matter lesions

Question 10

oligoclonal bands

Answer 10

• their presence in CSF indicates production of a few clones of antibodies in the CNS
• also increased Ig synthesis in CSF may be detected

Question 11

evoked potentials

Answer 11

• computer averaged cortical responses to visual, auditory, or electrical stimuli
• delayed or absent response suggests a lesion in that system which may be an MS plaque

Question 12

brain MRI scan (sagittal FLAIR sequence) without contrast

Answer 12

may show high signal MS lesions in the periventricular white matter, radially oriented like “fingers” in the corpus callosum

Question 13

MS tx

Answer 13

• fever control
• iv high dose corticosteroids
• beta-interferon or glatiramer acetate