neuro Flashcards
What is Multiple Sclerosis
- An immune-mediated disease of the central nervous system
- A disease of myelin and axons
- primarily diagnosed clinically
For MS, where are Immune cells are made throughout the body?
• Tonsils • Thymus • Bone Marrow • Spleen • Lymphoid tissue of the gut ******EXCEPT the brain and spinal cord******
Tell me about the Nerve Damage and Myelin Loss pathway
A. Normally, axons have a protective myelin coating that is necessary for normal conduction of electrical impulses
B. In MS, the immune system destroys myelin, resulting in slowed (not absence) conduction and exposure of axons
C. Exposed axons may then be severed…
D. …leading to permanent loss of the axon
E. The result is permanent loss of nerve function
What are common MS presenting s/s?
- Spasticity
- Gait, balance, and coordination problems
- Speech/swallowing problems
- Tremor
- *****s/s unpredictable
between ages is MS usually dx?
20-50
risk factors with MS
risk is higher in any family in which there are several family members with the disease (multiplex families)
What happens with Myelin in Chronic Multiple Sclerosis Lesion?
In Early MS lesions as “shadow plaques,” which are areas of thinly remyelinated axons.
What will You Do in the Diagnosing MS?
- The core requirement for the diagnosis →dissemination in time and space: evidence that damage has occurred in at least two separate areas of the CNS at different points in time
- There must be no other explanation
- Diagnosis of MS require evidence of plaques that occurred in different places in the CNS at different points in time
- Clinical findings alone or a combination of clinical and MRI findings
- Can sometimes take months or even years to confirm the diagnosis
WHAT IS Dissemination in space
demonstrated with MRI by one or more T2 lesions in at least two of four MS-typical regions of the central nervous system (periventricular, juxtacortical, infratentorial, or spinal cord) OR by the development of a further clinical attack implicating a different central nervous system site. For patients with brainstem or spinal cord syndromes, symptomatic MRI lesions are excluded from the criteria and do not contribute to lesion count.
WHAT IS Dissemination in time
demonstrated with MRI by the simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time, OR a new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan, or by the development of a second clinical attack
What is the test of choice to support the clinical diagnosis of MS
MRI
T/F: Most patients with MS have relapsing-
remitting disease
TRUE
role of lumbar puncture with MS:
not a requirement for the diagnosis of MS in patients with classic MS symptoms and brain MRI appearance- but - it can be used to help rule out the diagnosis in equivocal cases
What is Evoked potential testing
- electrical events generated in the central nervous system by peripheral stimulation of a sensory organ
- *Used to detect subclinical, abnormal central nervous system function
- *Detection of a subclinical lesion in a site remote from the region of clinical dysfunction supports a diagnosis of multifocal MS
- *Evoked potentials also may help define the anatomical site of the lesion in tracts not easily visualized by imaging (eg, optic nerves, dorsal columns).
what is a Clinically Isolated Syndrome (CIS)
**A first neurologic event suggestive of demyelination
• pt with CIS are at high risk for developing MS if the neurologic event was accompanied by multiple, clinically silent (asymptomatic) lesions on MRI typical of MS
Name the four stages of MS and describe
- Primary Progessice MS [ppms]- gradual progession of disease since onset without remission/relapse
- Relapsing/Remitting MS [rrms]- unpredicatable attacks which may or may not leave permanent deficits followed by periods of remission
- Secondary Progressive MS [spms]- initial rrms that progressed to progessive ms/ sudden steady decline without remission/relapse
- Progressive relapsing MS [prms]- steady decline since onset with SUPER-imposed attacks
define relapse with ms
new symptom or sudden worsening of old symptom lasting at least 24 hours, and usually accompanied by an objective change in neurologic findings
in a pt with rrms, how would the np manage a relapse?
- Treatment with corticosteroids recommended if relapse significantly interferes with everyday functioning
- 3-5 day course of high-dose intravenous methylprednisolone with or without oral taper
- High-dose oral steroids may also be used
- Rehabilitation can help restore function following a relapse
How would the NP medically treat MS?
• Baclofen (Lioresal) – oral; intrathecal or procedure with • Baclofen pump
T/F: Temperature Sensitivity is common with pts with MS
TRUE: Heat sensitivity is common AND cold sensitivity may occur too
What is pseudoexacerbation
When even a slight elevation in core body temperature in MS pt can cause temporary worsening of symptoms
What is Parkinson’s Disease?
a chronic, progressive neurodegenerative disorder characterized by any combination of four cardinal signs: rest tremor, rigidity, bradykinesia, and gait disturbance.
what are the 4 cardinal signs of parkinsons diease?
rest tremor, rigidity, bradykinesia, and gait disturbance.
