Multiple Sclerosis

Question 1

Diagnosis indications for CT

Answer 1

head trauma, acute intracranial hemorrhage, tumor/mass, acute/chronic headaches, meningitis, intracranial calcification, fractures, spinal trauma, bone lesions, degenerative spinal disease.

Question 2

Diagnosis indications for MRI

Answer 2

head trauma, acute/chronic intracranial hemorrhage, tumor/mass, demyelinating disease/lesion, chronic headache, vascular malformations, aneurysm, infection, degenerative spinal disease.

Question 3

Indications for CT

Answer 3

lower in cost, speed, claustrophobic, obese (>300lbs) pacemaker or metal fragments in heart or eye

Question 4

Indications for MRI

Answer 4

anatomical detail needed, nonspecific white matter lesions

Question 5

MRI pros/cons

Answer 5

pros-sensitivity/specificity, no radiation, safe contrast agents, excellent soft tissue resolution, white matter lesions
cons-slow, claustrophobia, strong magnetic field, poor bone detail

Question 6

MRI reading: T1

Answer 6

lesions mostly dark
dense bone, air and water all dark
fat bright

Question 7

MRI reading: T2

Answer 7

looks like a negative
CSF, edema, demyelination are bright white
dense bone and air dark
fat, water, and abnormal tissue bright

Question 8

Neuroanatomy of MS

Answer 8

CNS
UMN- cortical, brainstem, spinal cord
other- cerebellum, other

Question 9

Prevalence/incidence of MS

Answer 9

young adults
women more than men
20-40 peak onset

Question 10

Etiology of MS

Answer 10

unknown

environmental- vit D deficiency

Question 11

Pathogenesis of MS

Answer 11

inflammatory (autoimmune) degenerative disease
acute CNS inflammation-autoimmune response against CNS antigens, T cells cross blood brain barrier, recognize myelin as foreign and attack, this causes demyleination and axonal injury

Question 12

hallmark sclerotic plaque

Answer 12

end stage of process-areas of myelin and oligodendrocyte loss filled with inflammatory infiltrate

Question 13

Disease course

Answer 13

insidious, episodic
initial insidious or acute neurologic sign/symptom (sensory, weakness, vision common), then symptoms resolve, then 2nd neurologic insult, then MRI and other diagnostic testing, then diagnosed with MS

Question 14

5 diseases courses

Answer 14

clinically isolated syndrome (CIS)
relapsing-remitting
secondary progressive
primary progressive
progressive-relapsing

Question 15

clinically isolated syndrome

Answer 15

first event

risk of developing MS

Question 16

relapsing-remitting MS (RRMS)

Answer 16

disease attack with subsequent with subsequent recovery
little or no neurologic deficits between attacks
stepwise increase in neurologic deficits over years
90% of patients

Question 17

secondary progressive MS (SPMS)

Answer 17

relapsing and remitting MS attacks are followed by incomplete recovery
cumulative loss of function and disability
conversion occurs 6-10 yrs after initial symptoms
85-90% of patients with RRMS

Question 18

primary progressive (PPMS)

Answer 18

10% of patients
slow, steady progress of neurologic deficits
symptoms and signs are usually spinal
no obvious attacks, insidious progression
more common in late onset MS

Question 19

progressive-relapsing MS (PRMS)

Answer 19

less then 5% of cases

progressive disease with clear acute relapses

Question 20

initial symptoms

Answer 20

sensory, weakness, visual loss (optic neuritis), ataxia, diplopia, vertigo, fatigue

Question 21

symptoms during disease course

Answer 21

weakness, sensory, ataxia, bladder, fatigue, cramps, diplopia, visual loss, bowel, dysarthria

Question 22

parasethesia

Answer 22

abnormal spontaneous sensations; burning, tingling, pins and needles
feeling like the leg is on fire

Question 23

dysesthesia

Answer 23

unpleasant sensation produced by a stimulus that is usually painless

Question 24

allodynia

Answer 24

experience of pain from a non painful stimulation

Question 25

hypoesthesia

Answer 25

loss of sensation/numbness

Question 26

cerebellar clinical findings

Answer 26

ataxia "lack of order"
intention tremor (terminal dysmetria-under/overshoot as limb approaches target)

Question 27

ataxia

Answer 27

disordered contractions of agonist and antagonist muscles and lack of normal coordination between movements at different joints
includes dysrthythmia (adnormal timing)
includes dysmetria (abnormal trajectory)
appendicular (extremities-cerebellar hemispheres)
truncal (wide BOS-cerebellar vermis)

Question 28

in order to make a diagnosis

Answer 28

find evidence of damage in at least two separate areas of the CNS
find evidence that the damage occurred at least one month apart
rule out all other possible diagnoses
1-multiple episodes of neurologic symptoms
2-MRI multiple lesions
3-CFS positive oliogoclonal bands

Question 29

medical management

Answer 29

glucocorticoids for acute exacerbations
disease modifying therapies
symptomatic therapies
look at spasticity, neuorpathic pain, bladder/bowel dysfunction

Question 30

better prognostic factors

Answer 30

female, onset (relapse-remitting, optic neuritis, sensory, complete recovery), younger are at onset, long attack intervals, low freq attacks early on

Question 31

worse prognostic factors

Answer 31

male, onset (polysymptomatic, motor, incomplete recovery), increased age at onset, more frequent attacks, high freq attacks early on

Question 32

intervene

Answer 32

help maintain mobile and prevent secondary complications
help guide recovery after an exacerbation
consider fatigue and heat sensitivity for some patients