MS PBL Flashcards
what is pathology of MS
multifocal, immune mediated inflammation that results in demylenation and axonal damage
2 types of damage that can occur to a nerve
inflammation/demylenation - reversible
axonla damage - irreversible
what is mech of recovery in MS
remylenation with smaller mylen segments leads to slowed conduction speeds
what is epidem. of MS
3:1 females - caucasian, between 15-50
3 subtypes of MS
- relapsing remitting - 85%
- primary progressive
- prgressive relapsing
what is first attack in RR types
clinically isolated syndrome
what is onset, duration and recovery of CIS
onset - days
duraiton: weeks
recovery: complete
3 most common intial Sx
- sensory Sx in LIMBs only
- optic neuritis
- acute weakness
what is seen on MRI in CIS
multiple lesions indistiguishable from MS
what happens to MS pattern over time
moves from RR subtype to secondary porgressive
what does “multiple” in MS apply to
multiple in space and time
common MS Sx (7)
- fatigue
- impaired vision
- brainstem : diplo, vertigo,
- cerebellar: ataxia, incoordination
- sensory
- motor weakness
- sphyncter
avg. time to progresison from RR to SP
6-10 years
key diagnostic factors in MS
clinical
bloods to rule out other
MRI and CSF sensitivity increases with time
what type of MRI to use
cranial more sens. that spine, but over 50 spinal is more specific
what is seen in MS MRI
95% abnormal in MS
- multiple white matter lesions around lateral ventricles
- usually irregular shape
2 times when spinal MRi is good
- old PTs (>50)
2. when cranial was normal
when else might one see MRI lesions
- small vessel disease
2. other stuff
5 times to questions MS diagnosis
- age out of 15-60
- race
- clinical - findings ascribable to single lesion
- course - steady
- CSF and MRI persistently normal over years
time from onset to use of a cane
30 years - worse in PP
bad prognostic factors
- high relapse rate
- short interval
- male
- incomplete recovery
- older age at onset
goals of disease modifying treatments
- improve recovery form acute attacks
- prevent attacks
- prevent onset of progressive
- halt progression
what about steroids
NOT effective in preventing or slowing progresison and have bad SEs
when are disease modifying treatments indicated
only durinr RR phase
