Multiple Sclerosis (3Q) Flashcards

1
Q

MS: Patient

A

Usually under 55 yo, F>M. Western European or non-tropical ancestry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MS: symptoms

A

Sx occur suddenly and last a few days to weeks:

Weakness, numbness, tingling, diplopia, sphincter disturbance (urgency/hesitancy).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MS: Px

A

Optic atrophy, nystagmus, dysarthria, pyramidal, sensory, or cerebellar defects. Signs of upper motor lesion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CIS

A

Clinically isolated syndrome- a single MS attack.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Relapsing-remitting MS

A

Interval of months to years between symptoms. Relapses are followed by incomplete remissions and ultimate disease progressoin. Most common type.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Secondary progressive MS

A

Clinical course of disease in relapsing-remitting patient changes to a steady deterioration that is unrelated to relapses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Primary progressive MS

A

Least common. Sx are steady and progressive from a relatively early stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some MS triggers?

A

Heat, infections. 2-3 months following pregnancy, stress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T1 weighted MRI of brain in MS shows…

A

hypointense black holes representing permanent damage due to lesions. Some lesions may be hyperintense.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T2 weighted MRI of brain in MS shows…

A

Total number of lesions, cumulative burden of disease. Typically lesions appear as areas of high signal intensity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gadolinium-enhanced MRI of brain in MS shows…

A

areas of active inflammation with breakdown of BBB–this indicates new/active lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Arnold-Chiari malformation

A

parts of cerebellum and the lower brainstem are displaced into cervical canal producing mixed pyramidal and cerebellar deficits in limbs.
**Always visualize foramen magnum region to r/o. Causes MS-like symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MS: CSF findings

A

mild lymphocytosis, slightly increased protein. Elevated IgG w/ discrete oligoclonal bands. These are all non-specific.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is required for a diagnosis of MS?

A
  1. Dissemination in space (2 or more regions of central white matter affected. In patient w/ single attack, repeat image in a few months)
  2. Dissemination in time (multiple symptomatic attacks OR enhancing and non-enhancing lesions on MRI).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is required to diagnose primary progressive MS?

A

Minimum 1 year of progressive disease + 2/3 of:

  1. at least 1 typical brain lesion
  2. at least 2 spinal lesions
  3. oligoclonal banding of CSF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should you recommend for patient with CIS?

A

Follow up MRI in 6-12 months. Refer to neurology for possible treatment with beta interferon or glatiramer acetate, which may delay progression.

17
Q

Acute MS attack: Tx

A

IV corticosteroids (methylprednisolone 1g/day * 3 days). Follow w/ oral prednisone fore 1 week (60-80mg) and a taper over next 2-3 weeks (current).

18
Q

Relapsing-remitting MS: preventative Tx (1st line)

A

IM/Subcutaneous: beta interferon (1a, 1b); glatiramer acetate;

PO: fingolimod

19
Q

Progressive MS: Tx

A

Immunosuppressive treatment:

Rituximab, cyclophosphamide, azathioprine, methotrexate.

20
Q

Treat severe relapses refractory to corticosteroids with:

A

plasmapherisis