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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
trigeminal neuralgia feels like
acute piercing electric shock-like pain
26
other symptoms
weakness visual disturbances spasticity heat sensitivity bladder dysfunction
27
visual disturbances
optic neuritis
28
optic neuritis
common presenting complaint transient abrupt loss of vision over 2-3 days
29
what is spasticity d/t
UMN involvement
30
dx
difficult and largely clinical
31
what does dx require
very accurate history that may reveal vague complains that have gone on for years w/o being dx
32
what picks up a new lesion
MRI w/ gadolinium
33
evoked potentials
measures conduction velocity along visual/auditory, sensory pathways to detect demyelination
34
CSF contains
gamma globulin and WBCs
35
definitive MS
documentation of 2 separate neurological lesions in the CNS that are temporally (greater than 30 days apart) and spatially distinct (anatomically separate)
36
primary progressive MS
a slow progression of S&S over at least 6 months is required for dx
37
confirming MS dx
MRI, EP, CSF
38
medication
high dose of corticosteroids and immunomodulators
39
high does corticosteroids
high does of IV methylprednisolone
40
what do high does corticosteroids the treatment of choice for
acute exacerbations
41
how do high dose corticosteroids treat acute exacerbations
limits inflammatory response reduces tissue edema restoration of the BBB immunomodulation
42
immunomodulators
CRAB
43
C - CRAB
copaxone glatiramer acetate
44
R - CRAB
rebif interferon beta 1a
45
A- CRAB
avonex interferon beta 1a
46
B - CRAB
betaseron interferon beta 1b
47
betaseron
has been shown to be effective in decreasing the frequency and severity of RR MS less effective in chronic progressive MS
48
side effects of betaseron
flu like symptoms
49
other medications
mitoxantrone (novantrone) methotrexate (cytoxan)
50
mitoxantrone
for worsening RR, PR, SP
51
methotrexate
for SP suppresses the immune system
52
rehab considerations
fatigue and exercise
53
there is a
fear of fatigue lifestyle of inactivity and physical deconditioning and disuse
54
how can exercise help w/ fatigue
when administered correctly and appropriately --> can help modulate fatigue symptoms and prevent deconditioning
55
Exercise
can exacerbate fatigue will not cause further neurologic damage or increase the likelihood of having a further relapse or exacerbation
56
over-exercising can
cause significant danger of injury to a person w/ MS
57
fatigue may lead to
to the start of using inappropriate movement patterns or increases fall risk
58
what should be carefully considered
the type of exercise given to people w/ MS they have a decreasing ability to tolerate certain amounts of exercise
59
when should exercise be scheduled
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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