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Neuro 1 - Exam 4 > MS - RS > Flashcards

MS - RS Flashcards

1
Q

what is MS

A

autoimmune dz

characterized by a course of inflammatory attacks leading to demyelination and slowing down of saltatory conduction in CNS

eventually halting

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2
Q

where is MS

A

there will be multiple areas of scarring (Sclerotic tissue) or plaques

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3
Q

glial scarring

A

reactive astrogliosis

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4
Q

what is disrupted

A

BBB

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5
Q

what does a disrupted BBB cause

A

triggers astrogliosis and production of brain antigen called Glial Fibrillary Acid Protein (GFAP)

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6
Q

what do macrophages do

A

initiate destruction of myelin sheaths and cell bodies of oligodendrocytes

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7
Q

what do fibrous astrocytes do

A

fill the demyelinated areas and form the glial scar or plaque

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8
Q

dz characteristics

A

episodes of CNS inflammation called attacks, relapses or exacerbations

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9
Q

more characteristics

A

astrogliosis (glial scarring)

destruction of myelin

destruction of oligodendrocytes

irreversible axonal damage

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10
Q

demyelinating lesions of MS are termed

A

plaques

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11
Q

plaques

A

have sharply delineated lesions that can be viewed on MRI

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12
Q

typical lesions are where

A

in the periventricular region of the lateral ventricles and the optic nerves

often a primary lesion

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13
Q

how can MS present

A

number of ways

depending on where the lesion is located

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14
Q

most frequently reported symptoms

A

fatigue (88%)

gait disturbance (87%)

BB issues (65%)

pain and other sensations (60%)

visual disturbance (58%)

cognitive deficits (44%)

tremors (41%)

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15
Q

what is the most common single complaint

A

fatigue

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16
Q

fatigue

A

out of proportion to the task that is causing it

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17
Q

sensory symptoms

A

anesthesia

Lhermitte’s sign

trigeminal neuralgia

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18
Q

anesthesia

A

rare

paresthesia and dysesthesia are more frequent

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19
Q

paraesthesia

A

tingling

pricking

numbness

pins & needles

“falling asleep”

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20
Q

dysesthesia

A

abnormal sensations such as burning, itching, electric shock, wetness, tight banding

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21
Q

“MS hug/girdle band” sensation

A

feeling of having a tight band around chest or ribs

pressure on one side of torso, may make it painful to breath

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22
Q

Lhermitte’s sign

A

shock like sensation in the spine or LEs produced by rapid neck flexion

as in coughing

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23
Q

what is Lhermittes sign indicative of

A

dorsal column demyelinating damage

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24
Q

trigeminal neuralgia

A

found in a small # of pts (3%)

results from demyelination of CN V in the pons region

25
Q

trigeminal neuralgia feels like

A

acute

piercing

electric shock-like pain

26
Q

other symptoms

A

weakness

visual disturbances

spasticity

heat sensitivity

bladder dysfunction

27
Q

visual disturbances

A

optic neuritis

28
Q

optic neuritis

A

common presenting complaint

transient

abrupt

loss of vision over 2-3 days

29
Q

what is spasticity d/t

A

UMN involvement

30
Q

dx

A

difficult and largely clinical

31
Q

what does dx require

A

very accurate history that may reveal vague complains that have gone on for years w/o being dx

32
Q

what picks up a new lesion

A

MRI w/ gadolinium

33
Q

evoked potentials

A

measures conduction velocity along visual/auditory, sensory pathways to detect demyelination

34
Q

CSF contains

A

gamma globulin and WBCs

35
Q

definitive MS

A

documentation of 2 separate neurological lesions in the CNS that are temporally (greater than 30 days apart) and spatially distinct (anatomically separate)

36
Q

primary progressive MS

A

a slow progression of S&S over at least 6 months is required for dx

37
Q

confirming MS dx

A

MRI, EP, CSF

38
Q

medication

A

high dose of corticosteroids and immunomodulators

39
Q

high does corticosteroids

A

high does of IV methylprednisolone

40
Q

what do high does corticosteroids the treatment of choice for

A

acute exacerbations

41
Q

how do high dose corticosteroids treat acute exacerbations

A

limits inflammatory response

reduces tissue edema

restoration of the BBB

immunomodulation

42
Q

immunomodulators

A

CRAB

43
Q

C - CRAB

A

copaxone

glatiramer acetate

44
Q

R - CRAB

A

rebif

interferon beta 1a

45
Q

A- CRAB

A

avonex

interferon beta 1a

46
Q

B - CRAB

A

betaseron

interferon beta 1b

47
Q

betaseron

A

has been shown to be effective in decreasing the frequency and severity of RR MS

less effective in chronic progressive MS

48
Q

side effects of betaseron

A

flu like symptoms

49
Q

other medications

A

mitoxantrone (novantrone)

methotrexate (cytoxan)

50
Q

mitoxantrone

A

for worsening RR, PR, SP

51
Q

methotrexate

A

for SP

suppresses the immune system

52
Q

rehab considerations

A

fatigue and exercise

53
Q

there is a

A

fear of fatigue

lifestyle of inactivity and physical deconditioning and disuse

54
Q

how can exercise help w/ fatigue

A

when administered correctly and appropriately

–> can help modulate fatigue symptoms and prevent deconditioning

55
Q

Exercise

A

can exacerbate fatigue

will not cause further neurologic damage or increase the likelihood of having a further relapse or exacerbation

56
Q

over-exercising can

A

cause significant danger of injury to a person w/ MS

57
Q

fatigue may lead to

A

to the start of using inappropriate movement patterns or increases fall risk

58
Q

what should be carefully considered

A

the type of exercise given to people w/ MS

they have a decreasing ability to tolerate certain amounts of exercise

59
Q

when should exercise be scheduled

A

time of increased energy may be more effective

although pt may want to use those times for other activities

Neuro 1 - Exam 4 (12 decks)

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