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Neuro > neuro 20 > Flashcards

neuro 20 Flashcards

1
Q

geographically, MS is most common in which latitudes?

A

northern

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2
Q

common initial presenting symptom of MS

A

optic neuritis (mildly painful loss of visual acuity in one eye)

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3
Q

transverse myelitis

A

describes area of inflamatory demyelination in the SC

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4
Q

internuclear ophthalmoplegia

A

characteristic finding in MS; results from dysfunction in MLF and leads to inability to adduct one eye when looking oward the opposite side, with nystagmus of the abducting eye

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5
Q

INO in a young person

A

think MS

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6
Q

Lhermitte’s sign

A

characteristic of MS; tingling sensation down the spine when the patient flexes the neck

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7
Q

Unthoff’s phenomenon

A

worsening of symptoms in the heat

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8
Q

most MS patients begin with what type of MS course?

A

relapsing-remitting that evolves into secondary progressive

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9
Q

benign MS

A

few attacks, with return to normal between attacks

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10
Q

relapsing-remitting MS

A

no new disability between attacks; but overall the disease keeps getting worse

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11
Q

secondary progressive MS

A

evolving from relasing-remitting, there is a progressive disability with or without attacks

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12
Q

primary progressive MS

A

steady increase in disability without attacks

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13
Q

features predicting a good prognosis with MS

A

young age at onset, female, rapid remission of initial sx, mild relapses that leave little or no residual defecits, and presentation w sensory as opposed to motor deficit

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14
Q

MRI new and old MS lesions

A

new is discrete T2-hyperintense areas in the white matter of the brain or SC; old lesions may be T1-hypointense with black hole appearance

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15
Q

MS lesions have a predilection for what areas of the brain

A

periventricular white matter, juxtacortical regions, corpus callosum, and cerebellar peduncles

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16
Q

Dawson’s fingers

A

seen on sagittal MRI image; foci of demyelination spreading perpendicularly from the corpus callosum

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17
Q

characteristic CSF finding in MS

A

oligoclonal bands, found in more than 90% of MS patients at some point during the illness

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18
Q

what are the oligoclonal bands found in MS patient CSF

A

intrathecal (into the subarachenoid space with the CSF) production of IgG

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19
Q

visual evoked potentials

A

can be used in suspected MS to document evidence of old optic neuritis; increased latency of the P100 wave on the affected side

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20
Q

how are acute MS changes on path different from chronic?

A

chronic show axon loss and extensive glial proliferation

21
Q

how to treat acute relapses of MS

A

corticosteroids (IV methylprednisolone followed by an oral prednisone taper)

22
Q

therapies for the chronic treatment of MS

A

immune-modulating agents like beta-1a and 1b interferon

23
Q

what to check in patients receiving interferons for MS

A

CBC and liver enzymes because they can cause leukopenia and transaminitis

24
Q

Glatiramer acetate

A

polypeptide formulation injected subcutaneously that is also used in relapsing-remitting patiens

25
Q

Natalizumab

A

for patients that do not respond to interferons or glatiramer acetat; or who have progressive disease at onset; antibody that prevents lymphocytes and monocytes from crossing the BBB

26
Q

Fingolimod

A

mixed ag/antag of some receptor; first oral med fro MS; sequesteration of autoreactive T cells in lymph nodes; can lead to bradycardia

27
Q

how to manage spasticity in MS

A

baclofen, diazepam, or tizanidine

28
Q

how to manage bladder dysfunction in MS patienrs

A

anti0cholinergics (for urinary urgency) as well as self-catheterization

29
Q

acute disseminated encephalitis

A

monophasic illness leading to areas of demyelination in the CNS, usually following viral infectorion or vaccination

30
Q

ADEM lesions can occur anywhere but have a predilection for where?

A

posterior cerebal hemisphere

31
Q

behavioral and cognitive abnormalities can be seen in ADEM

A

whereas they are uncommon until very late MS

32
Q

CSF in ADEM

A

lymphocytic pleocytosis that is greater than that in MS; oligoclonal bands are rarely present

33
Q

prognosis of ADEM

A

neuro recovery is typically nearly complete

34
Q

treatment for ADEM

A

a course of IV corticosteroids is often administered to shorten the duration of the episode and lessen symptoms

35
Q

Neuromyelitis optica

A

transverse myelitis and optic neuritis; may develop simultaneously or there may be a delay of 1 or 2 years between them

36
Q

difference between NMO and MS

A

pain is worse in NMO; demyelination of the brain is absent or minor in NMO; deficits more severe in NMO

37
Q

CSF in NMO

A

pleocytosis seen more in NMO than in MS

38
Q

diagnosis of NMO

A

antibodies to aquaporin 4 channel

39
Q

tretment of NMO

A

steroids and also more aggressive measures like chemo and plasmapharesis

40
Q

prognosis of NMO

A

poor; patients develop blindness and paralysis in the long term

41
Q

progressive multifocal leukoencephalopathy

A

dementia, focal cortical dysfunction, and cerebellar abnormalities

42
Q

PML is almost exclusively seen in which patients?

A

patients with AIDS, leuemia, lymphoma, immunosuppressed, and other immunocompromised

43
Q

cause fo PML

A

JC virus

44
Q

how does JC virus lead to demyelination?

A

infects oligodendrocytes

45
Q

treatment of PML

A

not effective; mortality 50 percent

46
Q

posterior reversible encephalopathy syndrome

A

a leukoencephalopathy that often develops in the context of rapidly developing hypertension and eclampsia or is due to immunosuppresants used to prevent organ transplant rejection

47
Q

how does PRES present

A

acute confusional state and cortical visual loss (blindness with preserved pupillary reactivity)

48
Q

MRI for PRES

A

posterior white matter hyperintensities on T2-weighted images

49
Q

prognosis for PRES

A

not always reversible; can resul in coma or death

Neuro (43 decks)

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