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Foundations-Neuro > MS/MG & ALS > Flashcards

MS/MG & ALS Flashcards

1
Q

Define MS

A
  1. inflammatory demyelinating disease of CNS: Brain, SC, and optic nerve
  2. White and Grey matter
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2
Q

What gender is MS MC in? Age range?

A

Females

20-40 y.o.

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3
Q

MS etiology

A
  1. Autoimmune: HLA alleles
  2. Vitamin D deficiency
  3. Identical twins association
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4
Q

Define optic neuritis

A
  • Loss of vision in affected eye and pain with eye movement

- Phosphenes: Circular “stars”

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5
Q

Define acute transverse myelitis

A

Acute partial loss of:

  1. Motor
  2. Sensory
  3. Autonomic
  4. Reflex
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6
Q

Lhermittes Sign

A

“Barber shop” test

Neck flexion causes lightning-shock type pain radiation from spine down leg

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7
Q

What are the MC MS sx’s?

A
  1. Paresthesia, Trigeminal neuralgia
  2. Optic neuritis
  3. Acute Transverse myelitis
  4. Fatigue
  5. Autonomic SC sx: Bowel (constipation), bladder dysfunction
  6. Heat intolerance
  7. Ataxia
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8
Q

Uhthoff’s phenomen

A

Worsening symptoms with heat intolerance

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9
Q

Neuro PEx findings in MS

A
  1. Spasticity and Positive Babinski. (toes move up)

2. Ataxic gait

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10
Q

Eye PEx findings in MS

A
  1. Interneuclear Ophthlmoplegia

2. Nystagmus

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11
Q

What is the imaging of choice to help confirm and monitor the disease progression of MS?

A

MRI of brain and SC WITH Gadolinum

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12
Q

LP findings in CSF suggestive of MS

A
  1. Oligoclonal bodies

2. Immunoglobulin G (IgG)

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13
Q

MS diagnostic criteria

A

Dissemination in time and space

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14
Q

Management of acute MS exacerbations?

A

High dose corticosteroids (IV Methylprednisone)

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15
Q

First line treatment for RRMS to reduce frequency and severity of relapse?

A

B-Interferon or Glatiramer acetate

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16
Q

What helps with fatigue in MS?

A

Amantadine and Modafinil

17
Q

Define Myasthenia Gravis

A

Rare autoimmune disorder=antibodies against Ach postsynaptic receptor @ neuromuscular junction= Decreased Ach receptors= Progressive SKELETAL MUSCLE weakness

18
Q

Who is MG MC in? Age?

A

Young Females= 30’s

19
Q

MG Clinical Manifestations

A

Fluctuating, fatiguable muscle weakness

  1. Ocular weakness: Diplopia and ptosis
  2. Generalized muscle weakness: Bulbar and respiratory
20
Q

What is NORMAL in MG that. helps differentiate it from other diseases?

A
  1. Normal Sensory

2. Normal DTRs

21
Q

MG PEx

A
  1. Myasthenic snarl: Bilateral facial muscle weakness

2. Recovery after rest

22
Q

What is the most reliable test for diagnosing MG?

A

anti-acetylcholine receptor antibody test

23
Q

Why would you want to order a CT scan in MG?

A

Rule out Thymoma or thymus abnormality

24
Q

What is first line treatment in MG?

A

Anti-cholinesterase inhibitors

25
Q

List Anti-cholinesterase inhibitors

A
  1. Pyridostigmine

2. Neostigmine

26
Q

List immunosuppression therapy in MG and indication

A
  1. IV Immune Globulin (IVIg): in myasthenia crisis for rapid response
  2. Plasmapheresis
  3. Prednisone: Short and Long term benefit
27
Q

What is the major complication of myasthenia gravis

A

Myasthenia crisis= respiratory failure

28
Q

Define ALS

A

Mixed UMN and LMN neurodegenerative disease: Progressive motor degeneration

29
Q

What is another name for ALS?

A

Lou Gehrig’s disease

30
Q

UMN sx’s

A
  1. Spasticity in LE
  2. Stiffness
  3. Hyperreflexia
31
Q

LMN sx’s

A
  1. Progressive bilateral fasciculations
  2. Muscle atrophy
  3. Muscle weakness
  4. Hyporeflexia
32
Q

What dysfunction do we not see in ALS?

A

No dysfunction of:

  1. Cognitive/behavioral
  2. Sensory
  3. Autonomic
33
Q

What movements are spared in ALS?

A
  1. Urinary sphincter

2. Voluntary eye movements

34
Q

What are common first sx’s?

A
  1. Drop foot
  2. Walking
  3. Speech
  4. Dexterity
35
Q

Bulbar sx’s in ALS

A
  1. Dysphagia

2. Dysarthria

36
Q

Later stages in ALS

A
  1. Swallowing-Aspiration pneumonia

2. Intercostal-Poor lung function

37
Q

ALS treatment

A

Riluzole- Reduce progression by 2-3 months

38
Q

Riluzole MOA

A

Inhibits presynaptic release of Glutamate

Foundations-Neuro (5 decks)

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