B6.044 Prework 1: MS Symptoms and Diagnosis

Question 1

central symptoms of MS

Answer 1

fatigue
cognitive impairment
depression
unstable mood

Question 2

visual symptoms of MS

Answer 2

nystagmus
optic neuritis
diplopia

Question 3

speech symptoms of MS

Answer 3

dysarthria

Question 4

throat symptoms of MS

Answer 4

dysphagia

Question 5

MSK symptoms of MS

Answer 5

weakness
spasms
ataxia
loss of balance

Question 6

sensation symptoms of MS

Answer 6

pain
hypoesthesias
paraesthesias (tingling)

Question 7

bowel symptoms of MS

Answer 7

incontinence

diarrhea or constipation

Question 8

urinary symptoms of MS

Answer 8

incontinence

frequency or retention

Question 9

primary factors influencing diagnosis of MS

Answer 9

no single test
based on clinical exam, history, lab tests, and MRI
based on lesions being disseminated in time and space

Question 10

criteria for MS diagnosis

Answer 10

McDonald Criteria

Question 11

importance of early/effective treatment of MS

Answer 11

limits permanent damage to the CNS

may slow or prevent conversion to a more progressive form

Question 12

2 clinical attacks

2 lesions with objective clinical evidence

Answer 12

no other data needed

Question 13

2 clinical attacks

1 lesions with objective clinical evidence

Answer 13

need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI

Question 14

1 clinical attacks

2 lesions with objective clinical evidence

Answer 14

dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands

Question 15

1 clinical attacks

1 lesions with objective clinical evidence

Answer 15

need dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI
AND
dissemination in time demonstrated by an additional clinical attack by MRI
OR
demonstration of CSF specific oligoclonal bands

Question 16

4 types of MS

Answer 16

relapsing remitting (85%)
secondary progressive (50% of relapsing remitting patients within 15 years)
primary progressive (15%)
progressive relapsing (?)

Question 17

what is a relapse

Answer 17

• monophasic clinical episode with patient reported symptoms and objective findings typical of MS
• represent focal or multifocal inflammatory demyelinating event in the CNS developing acutely or subacutely
• duration of at least 24 hours
• with or without recovery
• absence of fever or infection

Question 18

relapsing and remitting course

Answer 18

characterized by relapses with stable neurological disability between episodes

Question 19

sequence of events in a relapse

Answer 19

symptoms develop over hours to days
symptoms can continue worsening for several weeks
symptoms slowly subside over weeks to months
residual symptoms can be present

Question 20

definition of progressive MS

Answer 20

steadily increasing objectively documented neuro disability independent of relapses
fluctuation, periods of stability, and superimposed relapses might occur

Question 21

events in progressive MS

Answer 21

gradual progression

often involves asymmetric leg weakness, ataxia, and spasticity

Question 22

diagnostic criteria of progressive MS

Answer 22

1. one year of disease progression
   PLUS 2 of the 3:
   -evidence for DIS in the brain based on >1 T2 lesions in at least 1 area characteristic for MS
   -evidence for DIS in spinal cord based on >2 T2 lesions in the cord
   -positive CSF for oligoclonal bands and/or elevated IgG index

Question 23

different activity levels of progressive MS

Answer 23

active with progression (relapses and clinical deterioration not due to relapses)
active but without progression (relapses but no clinical deterioration)
not active but with progression
not active and without progression (stable)

Question 24

what is clinically isolated syndrome

Answer 24

first presentation of neuro symptoms lasting at least 24 hours
caused by inflammation and/or demyelination
can be monofocal or multifocal
partial or complete recovery
high chance of developing MS

Question 25

etiology of initial relapses in relapsing-remitting disease

Answer 25

frequent inflammatory events that reach over the clinical threshold

Question 26

axon loss in relation to MS

Answer 26

early axon loss occurs does not correlate with inflammation clinical disability over time parallels axonal loss axonal loss > clinical threshold initiated secondary progressive disease course

Question 27

what can cause axonal loss

Answer 27

cyclical demyelination and remyelination events

Question 28

appearance of MS lesions on T2 MRI

Answer 28

white lesions appear fluffy can appear in white matter, corpus callosum, and spinal cord

Question 29

appearance of MS lesions on T1 MRI

Answer 29

IV admin of Gd reveals focal areas of BBB disruption | identified as high signal intensity regions

Question 30

cortical lesions in MS

Answer 30

can occur early and may have some relationship with cognitive impairment and physical disability some cortical lesions observed by pathological examination are not detectable by MRI

Question 31

spinal cord lesions

Answer 31

sensory and motor deficits on one or both sides below the lesion

Question 32

brainstem lesions

Answer 32

diplopia, ataxia, weakness, altered sensation of the face

Question 33

optic nerve lesions

Answer 33

blurry vision | painful eye movements

Question 34

cerebral lesions

Answer 34

most common cause least amount of symptoms many are silent if very large: numbness or weakness or other cortical function

Question 35

better prognostic factors for RRMS

Answer 35

``` female younger age white monofocal onset minimal cortical pathology onset w optic neuritis or isolated sensory symptoms low relapse rate high degree of remission after 1st relapse long interval to 2nd relapse mild relapse early ttx absence of oligoclonal IgG or IgM bands low disability at 5 years low lesion load on MRI ```

Question 36

worse prognostic factors for RRMS

Answer 36

``` male older age nonwhite multifocal onset early cortical pathology onset w motor, cerebellar or bladder/bowel symptoms high relapse rate short interattack latency short interval to 2nd relapse severe relapse late ttx presence of oligoclonal IgG or IgM bands disability at 2 or 5 years abnormal MRI ```