Neurology: MS Flashcards
What general type of nervous system lesions are observed in MS?
Motor: Upper motor neuron signs.
-hyperreflexia, Babinski
Sensory: vibratory, pain, temperature, touch lost
What is most typical for an MS diagnosis?
- male or female
- age 30 or 60
- South America or North America
- caucasian or Asian?
Female, in 30s, living in cooler climates (N. America), that is caucasian.
What is the Lhermitte Sign?
Sensation of “electricity” down the back after flexion of the neck.
-indicates lesion in the posterior column of the cervical spinal cord and MAY indicate MS.
Which cranial nerve is most commonly affected in MS?
CN II
-after presents as optic neuritis that leads to a gradual and PAINFUL loss of vision.
Optic neuritis in a young female is considered MS until it is ruled out.
Where is the lesion in a patient with Internuclear ophthalmoplegia?
Medial Longitudinal Fasciculus
-failure of eye adduction
What are 3 common psychiatric symptoms of MS?
- Depression (most common)
- Bipolar Disorder
- Cognitive Disorders
- memory loss
What is Uhthoff Phenomenon?
Vision changes that occur in patients with MS when exposed to heat.
(before MRIs patients were put in hot tubs to look for vision changes to diagnose MS)
Best way to diagnose MS.
History and Physical
What signs are very indicative of MS that can be obtained in H&P?
- Belt-like sensation commonly around T10 dermatome (MS tug)
- Dissemination of paresthesia or dysesthesia in space and time (many instances in different locations at different times b/c MS is remissive and recurrent)
What kind of features on MRI can indicate MS?
“Dawson Fingers”
-projections of demylination around the ventricular system
What are oligoclonal bands?
Bands of immunoglobulins that appear in both the serum and CSF during pathology (infection, autoimmune disorders, inflammation etc.).
They can indicate MS if the bands are in the CSF and NOT in the serum.
What are evoked potentials?
Measurements of nerve conduction velocity. Specific nerves can be measured and a decrease in conduction velocity can indicate demyelination or MS.
Name and describe the 4 types of MS.
- Relapsing-remitting MS: patients present with symptoms that disappear after a while and then return
- Primary Progressive MS: patients have no remission and the symptoms gradually get worse.
- Secondary Progressive MS: patients have relapse and remission early but eventually the symptoms remain and gradually get worse.
- Progressive Relapsing MS: symptoms come and go but they gradually get worse with progressive attacks.
What is unique about Primary-Progressive MS?
It is more prominent in older males (40-80 yrs.)
Best treatment for Relapse of MS.
Corticosteroids
