MS Patho Flashcards
What is MS
progressive inflam disease, damage of myelin in CNS
What age group and range is MS most common
young adults (70%), onset 20-40 yo
What is another age group that MS is common
between or after 60 yo, 10-20%
What are 4 triggers of MS
-sun
-vit D
-smoking
-epstein-barr virus (herpes)
What nerve cell is the most abnormal
oligodendrocytes
What cell causes inflammation? what are two other functions?
microglial cell
clear cellular debris and repair tissue
what is an astrocyte
supports CNS; provide synaptic support, neuronal guidance, and maintain blood brain barrier
What happens to astrocytes with MS
decreased BBS
What are T cells? what happens to them in MS
WBC that destroys pathogens
autoreactive in periphery (autoimmune mediated)
Describe the 6 steps of T cell autoimmune disease
- T and B cells cross weakened BBB
- T cells interact with B cells and microglia
- Antibody and cytokine release INFLAMMATION
- demyelination
- remyelination capacity exhausted
- neurodegeneration
What does repeated inflammation lead to
decreased repair –> axonal damage (irreversible disability)
What is a hallmark of MS
plaques: loss of myelin, fibrous astrocytes and undergoes gliosis
Which three structures are affected d/t axonal loss
SC (50%)
Optic nerve (25%)
brainstem cerebellum (25%)
which matter experiences a dysfxn
gray
what are 3 main environmental/geographical triggers
-decreased sun
-vit D lvls
-more common above 45 latitude
What are the 5 classifications of MS
-relapse remitting MS (RRMS)
-secondary progressive MS (SPMS)
-primary progressive
-benign MS
-progressive relapsing MS
What is relapse-remitting MS
85% of cases
-unpredictable attacks
-may/may not leave permanent deficits
What is secondary progressive MS
Initial RRMS that has sudden decline w/o periods of remission
What is primary progressive MS
15%
-gradual worsening symps
-don’t respond to med standard rx
-PROGRESSIVE MYELOPATHY
What is benign MS
One time then no reoccurrence
What is progressive relapsing MS
5%
-progressive course w/ clear relapses
-steady decline since onset w/ super imposed attacks
How to dx MS
-collection of tests
-confirm 2 lesions in at least 2 separate areas of brain, SC, or optic n
AND
-damage in 2 different points in time
AND
-rule out other diseases
Dx tools for MS
-MRI
-lumbar puncture
-visual evoked potential (VEP)
What is visual evoked potential (VEP)
-dx tool
-tests electrical activity of brain (optic n) in response to stimuli of visual n pathway
What are 5 differential dx for MS
-chronic LBP (common 1st issue)
-fibromyalgia
-cervical spondylosis
-herniated disc
-mitochondrial disease
What are 3 major/red flag initial symps
-fatigue
-visual disturbances (double vision)
-pain in B LE (sudden and spontaneous “shock”)
What are 8 s/s during flare up
-numb/tingle
-fatigue
-visual changes
-incontinence
-wk
-gait changes
-brain fog
-tremors
What is pseudo exacerbation
< 24 hours, resolves on own
-caused by stress, over exertion, or heat
-s/s: fatigue, brain fog, pain
What is “smoldering process of MS”
Continuation of disease
What are the three types of fatigue
Primary, indirect, neurologic
What is primary fatigue
Damage to axons, brain and SC (mus fatigue)
What causes indirect fatigue
Meds, depression
What causes neurologic fatigue
Spasms, wk, heat, energy failure
How does positive mood affect fatigue
Decreases
What is Uhtoff phenomenon
Increased core temp/heat intolerance
-correlated with fatigue
-caused by exertion, hot water, warm temp
What are 3 ways the motor system is affected
-wk brain and SC
-ataxia (cerebellar, dysmetria, tremor, dysdia…)
-SPASM (LE > UE)
What are 3 main causes of spasticity/hypertonicity
-pos changes
-noxious stim
-physiologic stress
What secondary issues does spasticity cause (4)
-contractures
-skin break down
-pain
-sleep disturbances
What are the 4 types of neuropathic pain
-acute
-trigeminal neuralgia
-Lhermitte’s sign
-chronic
What is Lhermitte’s sign
Brief stab of electrical shock through SC
What causes acute neuropathic pain
Demyelination of sensory neurons (anterolateral track)
What are 2-ish major sensory impairments
Visual and somatosensory/proprioceptive
What type of visual probs do MS pts experience (5ish)
-visual field loss
-diplopia
-blurry
-painful eye movement
-color desaturation
What are 3 common postural control probs
-delayed response to postural pertuberance
-increased sway in quiet standing
-inability to move outside BOS
3 bladder probs
-urinary urgency
-incontinence
-detrusor overactive
