Quiz 8 - MS, demyelination Flashcards
gender ratio of MS
2/3 are female
MS predisposition
HLA DR2
types of MS
1) relapsing-remitting
2) secondarily progressive - more aggressive, faster decline, less remission
3) primary progressive - no episodes, no sudden onset, diagnosed during illness with MRI
4) progressive relapsing - mix of decline with occasional episodes
what is an exacerbation/attack?
- neurologic disturbance
- lasts longer than 24 hours
- at least 30 days between attacks (shorter is just the same attack waxing and waning)
pathophysiology of MS attack
- Th cells activated for unknown reason
- attracted to vessels of BBB
- breakdown of BBB
- Th cells reencounter antigens in CNS
- attack CNS myelin
sensory symptoms of MS
- numbness/paresthesias
- can be poorly localized
- unilateral or bilateral
vision in MS
- optic neuritis very common
- double vision
motor problems in MS
- ataxia
- dysmetria
- hemiparesis possible
- bladder/bowel
- sexual dysfunction
MS symptoms increased by
overheating
easiest and hardest types of MS to diagnose
easiest - relapsing-remitting (most common)
hardest - primary progressive
classical definition of MS
multiple white matter lesions separated in space and time
is there a biological test for MS?
no
definitions of space and time
time - at least 30 days between clear symptoms
space - at least two anatomic events confirmed by imagery
diagnostic criteria for MS
- objective abnormalities of CNS
- white matter involvement predominant
- at least two lesions
- 2 or more events over 6 months
- no other disease explains it
diagnostic categories of MS
- at risk - all criteria are met except
has only been one episode and one finding on exam
no clinically isolated syndrome - probably MS - all criteria are met except
missing one event or one exam finding - clinically defined - all criteria are met
MRI criteria for the two lesions in space and time
space - two or more lesions in at least two of the following
- periventricular
- juxtacortical
- spinal cord
- infratentorial
time - change in lesions from one MRI to the next, or lesions at different stages in same MRI
utility of different MRI studies
T1 - look for black holes and atrophy
T2/FLAIR - disease burden via BPF
T1 + gadolinium - recent events
what is the BPF?
brain parenchymal fraction
- fraction of brain taken up by lesions
how does a FLAIR image work?
- de-emphasizes free water
- shows parenchymal lesions very well
Dawson’s fingers
radiation of plaques away from ventricles, best seen in sagittal FLAIR image
CSF positive for MS….
more than three oligoclonal IgG bands present
VER findings in MS
- either a delay or a weakened response to visual stimulus as seen on EEG
treatment of acute MS attack
IV steroids
MS treatments, indications, and cautions
B-interferon - RRMS and CIS, has significant side effects
glatiramer acetate - RRMS, decoy for Th cells, less side effects than B-interferon but you have to take it every day
mitoxantrone - used in secondary progressive, toxic, cardiomyopathy possible
natalizumab - can cause leukoencephalopathy in JC virus
fingolimod - oral
