MS Flashcards
eye pathology
optic nerve infiltration
-dilation with light
positive MS findings
W>M
weakness and paresthesias
increased protein levels and oligoclonal bands on electrophoresis
Multiple T2 hyperintense areas consistent with demyelination are seen on MRI
initiating cause MS
UK, auto-immune medicated inflammatory demyelination and axonal injury
MS pathophys
1) Breakdown of the blood-brain barrier
2) Periventricular mononuclear infiltrates
3) Circumscribed areas of myelin breakdown
injury to CNS neuronal axons which may account for ??
brain atrophy and permanent damage seen in advanced disease
ddx
vasculitis paraneoplastic smCC neurosarcoidosis SLE, ALS, CNS disorders Behcet disease lymphoma HIV Lyme disease
MS symptoms
Unilateral visual impairment* Double vision* Paresthesias* Ataxia or unsteadiness* Vertigo Fatigue Muscle weakness Urinary disturbance Dysarthria Mental disturbance *see chart
MS signs
Optic neuritis Internuclear opthamoplegia (INO) Nystagmus Spasticity or hyperreflexia Babinski sign Absent abdominal reflexes Dysmetria or intention tremor (vs. resting tremor in Parkinson's) Impairment of central sensory pathways Labile or changed mood
INO
slowing of adduction w.out ocular limitation
*see slide
what imaging??
MRI»_space;> CT!
shows abn. in >85%
lesions: multifocal, hyper intense on intermediate and T2-weighted MRIs (enhanced with Gadolinium)
not just in brain: the periventricular white matter, corpus callosum, cerebellum, cerebellar peduncles, brainstem, and spinal cord
plaques that take over
LP??
see what in CSF
can be helpful in MS
CSF: Oligiconal bands, increased IgG synthesis, and moderate lymphocytic bands, increased IgG synthesis, and moderate lymphocytic pleocytosis (
myolograms
not as helpful as in Guillain Barre
MS types
know 1st 3
Relapsing-remitting MS (RRMS)-research, good px
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)*worse! never stops even w. aggressive tx
Progressive-relapsing MS (PRMS)
acute exacerbations tx
if that doesn’t work??
3-5 course high dose IV methylprednisilone (1 g/day)
sev. or steroid unresponsive: plasma exchange
tx to decrease relapse rate and intensity
Interferon beta-1b
Interferon beta-1a
Glatiramer acetate
