Multiple Sclerosis Flashcards
what are 3 characteristics of MS?
immune-mediated
demyelinating
central nervous system
what will be seen in histological exams of MS lesions? (3)
T cells
B cells
macrophages
what is the pathogenesis of MS?
focal demyelinated plaques with inflammation, gliosis, and axonal damage in the CNS
where are focal demyelinated plaques most commonly seen? (4)
optic nerves
spinal cord
brainstem
cerebellum
phase in which activated mononuclear cells destroy myelin and oligodendrocytes, macrophages pick up and degrade myelin, and myelin fragments turn into protein and lipids
active plaques (acute phase)
phase in which gliosis develops and demyelinated axons traverse glial scar tissue
inactive plaque (burned out stage)
what is the relative afferent pupillary defect or Marcus Gunn pupil?
affected pupil will dilated in response to direct light
an MS attack duration must be at least ____ hours and cannot have ____ or ____
24
fever
infection
what are the 3 most common symptoms of an initial attack?
sensory disturbances
motor weakness
visual complaints
what is the most common form of MS?
relapsing-remitting
a steady deterioration of MS
secondary progressive
symptoms of MS steadily progress from the onset, leading to early disability
primary progressive
what will a lumbar puncture with CSF show?
oligoclonal bands made of IgG
what are the 2 parts of the McDonald Criteria?
dissemination in space (2 or more regions affected)
dissemination in time (attacks at diff times)
characterized as a first attack OR the patient does not report symptoms but plaque is seen on imaging
Clinically Isolated Syndrome (CIS) / Radiographically Isolated Syndrome (RIS)
what should be done in the case of a CIS/RIS?
repeat MRI in 6-12 months
what is the diagnostic of choice for MS?
MRI of brain or spinal cord
what is the goal of treatment for MS?
partial recovery from exacerbations
what is the treatment for acute exacerbations of MS?
IV methylprednisolone x 5 days (or high dose oral steroids)
what treatment can reduce the frequency of attacks in MS? (3)
interferon injections
glatiramer acetate injections
dimethyl fumarate
what can we add if a patient has continued exacerbations while on interferon? (2)
antibodies:
natalizumab
alemtuzumab
what is the treatment for severe or progressive MS?
immunosuppressive therapy
Rituximab
what can be done for severe relapses of MS or if patient is unresponsive to steroids?
plasmapheresis
what can be completed by the patient to determine the index of clinical disability of their MS?
expanded disability status scale
what is the prognosis of MS?
life reduced by 7-14 years
half of deaths are related to MS complications, such as: (4)
infection
respiratory disease
cardiovascular disease
suicide
