MS Flashcards
1
Q
What causes MS? increased and decreased risks
A
- etiology is largely unknown, but most likely multifactorial - Environment: lower risk closer to the equator perhaps due to increased vit D from the sun. Smoking increases risk and progression - Genetic factors: non hereditary, but increased risk if parent or sibling has MS. Thought genetic predisposition with environmental factors - Infectious disease (human herpes virus-6, epstein barr virus, etc ) can cause demyelination and inflammation but are not known to cause MS
2
Q
how is MS diagnosed ?
A
- no one test - signs, symptoms, imaging, and exclusion of other dx - McDonald criteria: need 2 or more distinct attacks and 2 or more lesions in the CNS; OR progressive neuro sx > 1 year and 2 lesions
3
Q
What imaging/tests can be done to help dx MS ?
A
- MRI - Evoked potentials (only visual has been proven to be helpful in dx MS) - CSF analysis
4
Q
what can an MRI show you?
A
- detects plaque caused by myelin destruction and cerebral/SC atrophy - T1: active inflammation - T2: old and new lesions - FLAIR: displays brain or SC structures without CSF
5
Q
How is visual evoked potential tested and what does it test?
A
- use of alternating checkerboard pattern - identifies pathologic transmission along the optic nerve pathway
6
Q
What CSF findings are consistent with immune related conditions?
A
- Elevated IgG antibodies - Presence of oligoclonal bands - Certain proteins common with breakdown of myelin * these findings are not specific to MS and not all individuals with MS have CSF abnormalities
7
Q
General clinical presentation of MS
A
- Motor weakness and spasticity - Sensory changes and pain - Vision - Heat intolerance - Fatigue - Cerebellar dysfunction - Urinary changes - Cognitive changes
8
Q
Sensory changes
A
- Paresthesia - Loss of proprioception and vibratory sense - dysesthesia (more common than numbness)
9
Q
Vision changes
A
- optic neuritis (most common), blurred vision, changes in color perception, visual field deficit - nystagmus - oscillopsia -intranuclear opthalmoplegia (disruption of conjugate eye movements) - optic disc pallor: indicated optic disc atrophy
10
Q
Heat intolerance. Phenomenon and possible cause
A
- sensitivity to changes in core body temperature from internal and external sources - Uhthoff phenomenon: increased body temperature causes increased neurologic symptoms - neurobockade hypothesis: rise in temperature decreases nerve conduction in partially demyelinated fibers
11
Q
Fatigue
A
- very common symptom (`80%) - primary MS fatigue (caused by the disease): central or peripheral - central cause: failure of motor pathway during rapid activity due to demyelination - peripheral: overall decreased efficiency of motor unit activation: decreased oxidative capacity, slowing on contractile properties, decreased number of slow twitch fibers, lower tetanic and twitch tension in mms
12
Q
Cerebellar dysfunction
A
ataxia, incoordination, dizziness, and imbalance
13
Q
Urinary changes
A
- incontinence - incomplete emptying - increased frequency - at increased risk for UTI
14
Q
Cognitive changes
A
- depression - emotional liability - anxiety - decreased executive functioning
15
Q
Scale used for classification of MS disability. Levels and meaning
A
- Kurtzke Expanded Disability status scale (EDSS) - scale ranges from 0 (no disability) to 10 (death) - stages 0 -4.5 : able to walk independently - stages 5-10 have impaired ambulation
16
Q
Relapse remitting MS
A
- most common initial type of MS (80%) - increase systems lasting 1-3 months with full or partial return to baseline
17
Q
secondary progressive
A
- second stage of relapsing remitting (happens quicker if MS is untreated) - progressive worsening of sx - may or may not have relapses and remissions
18
Q
primary progressive
A
- more severe - steady worsening of symptoms - no relapses or remissions
