Neuroimmunology

Question 1

What is the most common manifestation of MS?

Answer 1

Visual/ Oculomotor 49%

Leg paresis paresthesia 42%

Question 2

Differentiate Lhermitte’s phenomenon and Uthoff’s phenomenon

Answer 2

L: Electrical paresthesia with neck flexion
U: Worsening ssx with increased body temperature

Question 3

What are the 2 most commonly implicated viruses in MS?

Answer 3

EBV and HHV 6

Question 4

What would one see in the brain of an acute MS patient?

Answer 4

Periventricular Pink MS plaques usually in the superolateral angle of the lateral ventricle. If old lesions gray color

Question 5

What is the prominent microscopic lesion in CHRONIC INACTIVE LESION OF MS?

Answer 5

Prominent demyelination with severe loss of oligodendrocytes

Question 6

What would CSF in MS look like?

Answer 6

Pleocytosis, mild < or equal to 25 cells/mm3
Oligoclonal bands 50-60% of clinically isolated syndrome
Increased IgG 3.3mg/day in 90% of pxs

Question 7

What is the McDonald criteria for MS?

Answer 7

1 EXCLUDE alternative
2 First attack by neuro dz
3 Second attack by MRI criteria/ CSF criteria or abnormal evoked potentials

Question 8

What agents may be used for MS treatment?

Answer 8

1 IFN beta1b
2 Glatiramer acetate
3 Natalizumab: inhibits 4 alpha 1 integrin receptor on lymphocytes, inducing anergey and anti-inflammatory Th2 cells

Question 9

What is the treatment for optic neuritis?

How about transverse myelitis?

Answer 9

IV methyprednisolone for BOTH

Question 10

How to differentiate ADEM from MS based on CSF?

Answer 10

ADEM has NO oligoclonal bands and usually occurs in close temporal relation to infection or vaccination

Question 11

Acute hemorrhagic leukoencephalitis a variant of ADEM is always preceded by?

Answer 11

Respiratory infection usually, Mycoplasma

Question 12

What do the arteries look on angiography for isolated CNS vasculitis?

Answer 12

Beading of arteries

Question 13

What is Eale’s dz?

Answer 13

Retinal perivasculitis, no known tx