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Medicine II: Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the process of demyelination?

A

a disruption of myelin, which is the coating around neurons

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2
Q

What produces myelin?

A

oligodendrocytes in the CNS

schwann cells in the PNS

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3
Q

What causes multiple sclerosis?

A

a disease of the CNS caused by an autoimmune attack on oligodendrocytes resulting in multiple areas of demyelination.

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4
Q

MS is one of the leading causes of what?

A

neurological disability in young adults

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5
Q

what are the risk factors of MS?

A

age, gender, genetics and environment

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6
Q

95% of those diagnosed with MS are in what age range?

A

15-55

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7
Q

What is the gender preference for MS?

A

females

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8
Q

What is the chance you will get MS if both of your patents have MS?

A

9%

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9
Q

What is the gene associated with the genetic component of MS?

A

HLA-DR2

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10
Q

What is an interesting caveat about where you live in regards to likelihood of MS?

A

individuals in the northern states have a 3x higher likelihood of developing MS then people in southern states. If someone moves before the age of 15, they will not carry the risk with them.

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11
Q

What are possible mechanisms of MS?

A

molecular mimicry and failure of colonal deletion

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12
Q

What is a hallmark of MS?

A

multiple scarred foci (plaques) with in the white matter of the CNS and perivenular inflammation

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13
Q

What happens when the myelin is disrupted?

A

decrease in saltatory conduction and action potentials are unable to be effectively transmitted down axons, leading to neurological dysfunction

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14
Q

What are the types of MS?

A

relapsing-remitting
primary progressive
secondary progressive
progressive relapsing

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15
Q

What is a clinically isolated syndrome?

A

1st episode of transient neurological dysfunction

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16
Q

What is relapsing remitting MS?

A

multiple episodes of transient neurological dysfunction which may or may not completely resolve. There is no progression between relapses.

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17
Q

What is primary progressive MS?

A

No defined relapse or remission. Disease progresses relentlessly from its onset

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18
Q

What is secondary progressive MS?

A

Patients with relapsing remitting MS may (after ~17 years) start to have some progression during relapses.

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19
Q

What is progressive relapsing MS?

A

relentless progression from the onset but may have a rare relapse

20
Q

What do we need to diagnose MS?

A

dissemination in time and space

can be fulfilled clinically or radiographically

21
Q

What are the common presenting signs and symptoms of MS?

A 
limb sensory loss - 31%
visual loss - 16%
sub acute weakness
diploplia
gait disturbance
vertigo
acute weakness
22
Q

What are two common clinically isolated syndromes associated with MS?

A

optic neuritis and transverse myelitis

23
Q

Is there a correlation between treatment and clinically isolated syndromes?

A

treatment after clinically isolated syndromes is showing to result in better outcomes and less disability over time

24
Q

What is optic neuritis?

A

demyelination of the optic nerve

characterized by the triad of :
visual acuity loss
dyschromatopsia
epsilateral eye pain especially with movement

25
Q

What does the neuro exam show for optic neuritis?

A

relative afferent pupillary defect

26
Q

What does an MRI show for optic neuritis?

A

increased T2 signal of the optic nerve

27
Q

What is the prognosis for optic neuritis?

A

good, complete or near complete recovery is expected

28
Q

What is transverse myelitis?

A

demyelination of the spinal cord; any of the ascending or descending tracts may be affected

29
Q

What are the typical symptoms of transverse myelitis?

A

sensory loss in one or both lower extremities often accompanied by a sense of heaviness.

30
Q

What does the neuro exam show for transverse myelitis?

A

spasticity, at sensory level, up going goes, and weakness

31
Q

What is commonly associated with transeverse myelitis?

A

L’hermitte’s Phenomenon- a lightning like pain that radiates down spine with head antero flexion

32
Q

In the physical exam what is seen with MS?

A

charcots triad: nystagmus, intention tremor, and scanning speech (staccato)

33
Q

What are the diagnostic tests for MS?

A

LP, MRI(T2 and FLAIR) and visual evoked potentials

34
Q

What is the only nerve myelinated by oligodendrocytes?

A

optic nerve

35
Q

What is seen on a lumbar puncture in a patient with MS?

A

oligoclonal bands; This represents increased synthesis within the CSF of antibodies

present in 95% of MS patients

36
Q

What do visuallly evoked potentials show in a positive diagnosis of MS?

A

increased latency to visual stimuli

37
Q

How do MS lesions typically appear on imaging?

A

periventricular (dawsons fingers) and ovoid

38
Q

How do we treat acute exacerbations of MS?

A

IV methylprednisone- 3-5 days (does not affect the progression of the disease, just increases recovery time)

*oral prednisone is a/w increased subsequent attacks

39
Q

What is the disease modifying treatment for MS?

A

inteferon beta 1a
inteferon beta 1b
copaxone- random peptide chain of the most common AA in myelin

40
Q

What is the prognosis of MS?

A

Good, 90% are independent 10 yrs after dx

41
Q

What are signs of a good prognosis?

A

female, relapsing-remitting, and optic neuritis at onset with infrequent exacerbations

42
Q

What is Guillian Barre Syndrome?

A

demyelination of PNS that is likely post infectious or post vaccination in nature

present with a rapidly progressing symmetric, ascending limb paralysis

43
Q

What are the main characteristics of Guillian Barre?

A

3A’s: acute onset, ascending paralysis, areflexia

44
Q

What can GBS lead to ultimatley?

A

Respiratory failure

45
Q

What are the post infectious causes of GBS associated with?

A

GI illnesses from C. jejuni

46
Q

What is the prognosis of GBS?

A

if caught early enough, full recover is expected

47
Q

What is the treatment for GBS?

A

IV IG or plasmaphoresis

Medicine II: Neurology (12 decks)

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