MS Flashcards
What are the three characteristics of a LMN? (Tone, reflexes, fasciculation)
Decreased tone and decreased reflexes
Fascciculations are present
Most common demyelinating disease:
MS
Hallmark of MS is:
Axonal injury
Locations of lesions in MS (5):
- Optic nerves
- Spinal cord
- Brainstem
- Cerebellum
- Juxtacortical and periventricular white matter
Three hallmarks of MS:
- Axon/neuron loss
- Demyelination
- Astrocytic glosis
Highest risk for MS and age data:
White females - onset is 5 years before men (average age is 20-50 *37 is dx age)
Low levels of white vitamin contribute to MS:
Vitamin D
Diagnosis criteria for MS:
Present as a young adult with two or more clinically distinct episodes of CNS dysfunction with at least partial resolution
Common signs and symptoms (3):
- Sensory limb changes
- Vision loss
- Motor/gait disturbances
What is Lhermitter’s sign in MS?
Transient sensory symptoms of electric shocks radiating down the spine and into the limbs when you flex the neck
What is an early sign of MS in young people?
Trigeminal neuralgia
Two visual disturbances in MS:
- Optic neuritis (most common)
- Internuclear ophthalmoplegia
What is optic neuritis? When do they recover?
Unilateral subacute eye pain that is increased with eye movement - followed by some vision loss (dampening of colors) - 90% return to normal in 2-6 months
Someone currently experiencing optic neuritis will have a:
Marcus Gunn pupil - lesion isolated retrobulbar
What would you see on a fundoscope exam of a person with optic neuritis?
Pale disc; temporal pale ness
What is most suggestive of MS when looking at someone’s eyes?
Bilateral INO
What is internuclear ophthalmoplegia? What happens with convergence?
Abnormal horizontal eye movements (cannot adduct the eye) - Result: nystagmus **CONVERGENCE IS PRESERVED
Where is the lesion in someone with INO in MS?
Medial longitudinal fasiculus on the side that CANNOT adduct anymore
There is quite a bit of spasticity in MS: Which extremity experiences it more?
Lower extremity
Extensor (babinski) test is ___ in someone with MS
Positive
DTRs and clonus in someone with MS?
DTRs are exaggerated and there is often clonus
What is disuse amyotrophy:
Affecting the small muscles of the hand
What is Uhtoff’s sign?
When neurological symptoms are worsened in MS when the body is overheated, exercise, fever or hot tub
MS is not ____
Progressive - instead it is normal to have relapses and remissions
What is the Clinical Isolated syndrome?
The first attack of the disease that shows symptoms (ex. optic neuritis) but does not fulfill the criteria
If you have CIS and MRI lesions your change of developing MS later is
60%
Most people seek medical attention after they have had a CIS and __
Are experiencing their much worse second episode - GET MRI
What is Relapsing-Remitting MS?
Defined relapses with recovery. No disease periods of progression in between. (City sky line)
What is Secondary progressive MS?
Initially like relapsing-remitting but then the patient beings to progress between each episode
The transition to RRMS to SPMS occurs when after disease onset?
10-20 years after onset
What category of MS causes the most neurological disability?
SPMS
What is Primary progressive MS?
Patient continues to get worse without periods of remission - NO ACUTE ATTACKs
Most common form of MS?
Relapsing-Remitting MS
What is the test of choice to Dx MS?
MRI - Will see plaques in the periventricular or corpus callous
What occurs at a rate of 0.5-1.5% each year in someone with MS?
Brain atrophy - Do not see this initially
What is another test you do to look for MS (quality assessment)? What are you looking for?
CSF - Looking for oligoclonal bands
What is Evoked potentials and what area is used the most?
Brain waves are recorded by stimulating a peripheral nerve - visual is used the most often
To diagnose MS you need what according to the McDonald criteria?
- Disseminated in space: one more more lesions in at least two of four MS areas of the CNS OR developing further clinical attacks in another area of the CNS
- Disseminated in time: PResnece of an asymptomatic lesion or a new lesion follow-up on MRI
* You need to have two distinct episodes of MS
Treatment of MS: acute and chronic
Acute: plasmapheresis and steroids
Chronic: immunotherapy - interferons and ab
When should you medicate someone with MS and spasticity?
If it is moderate - bento, gabapentin
Treatment of severe spasticity?
Cut the muscle or chemicals
If the patient is having bladder problems you should (2):
Rule out an infection and ultrasound
If someone with MS has urinary incontinence, you can prescribe them:
Antispasmotics
If someone is urinary retaining, you should suggest:
Self-catherization
