Neuro: Myasthenia Gravis & MS Flashcards
describe the bimodal distro of MG
20-40 (female)
60-90 (male)
etiology of MG
autoimmune AChR attack
2 hallmark sxs of MG
fluctuating fatigability & weakness
worse end of day or exercise
what can be seen on CXR in MG…
thymoma
Ptosis/diplopia occur in what percent of MG?
50%+
Three drugs that worsen MG
FLQ
BBs
hydroxychloroquine
patient cannot maintain upward gaze x 1 min
improved after cold pack admin
MG
Diagnostic tests for MG
NCS & EMG
AChR Ab
MuSK Ab
CT Chest (thymoma)
Sx tx for MG to improve strength
pyridostigmine (AChE Inhib)
Chronic immunotherapies for MG
GCs, azathioprine
Rapid immunomodulating agents
IVIG
plasmapheresis
surgical intervention for MG
thymectomy (remission possible)
who initiates tx of MG, what are 4 staples
neurology
- sxs tx
- chronic & rapid immunomodulators
- surgery
Imaging test of choice for MS
non-contrast MRI
The hallmark of MS is sxs that occur in different _______ and ______
different time
affect different locations
characteristic lesion on MRI for MS…
plaque
What type of MS?
initial RR/episodic MS then progressive worsening
occurs after 10-20 years of MS
secondary progressive
What type of MS?
progressive increase from onset, never remitting
primary progrssive
MC initial feature of MS
paresthesia
Young adult presents w. episodic hx of…
parasthesia
optic neuritis
weakness
MS
transient worsening of sxs due to elevated body temp with MS…
uhthoff phenomenon
assoc. w/ MS
neck flexion causes electrical shock sensation down back/limbs
lhermitte sign
assoc. w/ MS
defective pupillary reaction to light
marcus gunn pupil
Pt. p/w:
Visual loss
Motor disturbances
nystagmus
incoordination
tremor
hyperreflexia
(+) babinski
Clonus
(UMN signs)
MS
1st line tx for RRMS
slow progression of disease
disease-modifying therapies
1st line for MS exacerbation…
GCs (Methylprednisolone 1000mg IV QD x 5 days)
What must be r/o to dx acute MS exacerbation
infx
2 MS studies outside of MRI that can be helpful…
CSF analysis
evoked potential studies
