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Neurology 2 > ClinMed - MS > Flashcards

ClinMed - MS Flashcards

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1
Q

What is MS?

A

-immune mediated response by the body’s own immune system directed against the CNS

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2
Q

pathology progression of MS

A
  • system attacks the myelin, fatty covering of nerve fibers
  • myelin is damaged and scars form leading to degeneration and axonal death
  • scars or degenerated area interrupt the electric signal conduction of the nerve
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3
Q

what are the 3 areas effects in MS?

A
  • brain
  • SC
  • optic nerves
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4
Q

type of disease that classifies MS

A

demyelination

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5
Q

triad of risk factors for MS

A
  • genetic risk
  • environmental risk
  • immunologic risk
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6
Q

enviromental risk factors

A
  • low vit. D
  • northern latitude
  • smoking
  • obesity
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7
Q

immunologic risk

A
  • virus (EBV) trigger

- infectious agent

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8
Q

interesting stat about the epidemiology of MS

A

1:3 chance in monozygotic twins (not just genetic)

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9
Q

how to make the diagnosis of MS

A
  • no single test
  • best thing is MRI
  • and get a good hx
  • must be multiple events
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10
Q

criteria of MS diagnosis

A

-evidence of damage to at least 2 and separate areas of CNS
AND
-evidence that damages occurred at least 1 month apart
AND
-r/o other possibilities

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11
Q

what are the 3 possibilities to consider before establishing secure diagnosis?

A
  1. definite MS: meets mcdonald criteria
  2. probable MS: close to meeting mcdonalds + fam hx
  3. possible MS: doesn’t meet clinical or radiological criteria for definite diagnosis - this is a waiting game
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12
Q

mcdonald criteria

A
  • review this in slides

- not sure if it would be testable?

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13
Q

Dawson fingers

A
  • very classic MS lesions
  • demyelinating plaques through corpus callosum
  • right angles along medullary veins
  • present as T2 hyper-intensities
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14
Q

Black holes

A
  • hypointense lesions commonly seen in MS
  • indicates destruction, axonal loss and relatively severe CNS damage
  • seen in T1 modality
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15
Q

GAD enhancing lesions

A
  • during active inflammation, the BBB is disrupted
  • allows the gadolinium to pass through
  • GAD can enter CNS and leak into the new lesion
  • “new lesion” = in the past 6-8 weeks
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16
Q

describe an acute cord lesion

A
  • GAD enhancement

- spinal cord spelling

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17
Q

describe a chronic cord lesion

A
  • cord atrophy

- greater disability

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18
Q

Ddx in MS

A
  • AVM
  • other autoimmune: lupus, sjogren’s, sarcoidosis, ADEM, NMO
  • B12 or Cu deficiency
  • infection: lymes, syphilis, HIV
  • malignancy
  • migraine
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19
Q

general clinical manifestation categories of MS

A
  • eye
  • vertigo
  • ataxia
  • SC sx
  • cortical signs
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20
Q

clinical manifestions of MS in the eye

A
  • optic neuritis
  • nystagmus
  • diplopia
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21
Q

optic neuritis

A
  • painful eye movement
  • decrease in visual field
  • decrease in color saturation
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22
Q

clinical manifestation of vertigo

A
  • associated w/ adjacent structures
  • increased/decreased hearing
  • facial numbness
  • diploplia
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23
Q

clinical manifestations of ataxia

A
  • truncal: poor sitting balance

- limb: finger to nose, intention tremor

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24
Q

clinical manifestations of SC

A
  • nerve pain
  • L’Hermitte sign (when they tuck chin they feel electric shock over cape distribution)
  • neurogenic bladder > bowel
  • sexual dysfunction
  • weakness then spasticity
  • hyperreflexia
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25
clinical manifestations of cortical signs in MS
- poor mood - migraine - seizure - cognitive changes
26
sub types of MS
- relapsing remitting (MS) - secondary progressive - primary progressive
27
relapsing course of MS can be . .
- active or inactive | - worsening or not worsening
28
progressive courses of MS can be . .
- active w/ or w/o progression | - non active w/ or w/o progression
29
what falls under the umbrella term of probable or possible MS?
- CIS (clinically isolated syndrome) | - RIS (radiologically isolated syndrome)
30
CIS
- first attack - one scar seen - one exam finding
31
RIS
- incidental finding when MRI is done for another reason - immuno therapy is a weighted decision here - +/- fam hx of MS is helpful
32
what is the goal of immuno therapy?
- decrease future disability - reduce future lesion formation *no cure for MS and even w/ immunotherapy there can still be further lesion formation
33
MS tx options
- injections - oral - infusions - vitamins - IMT
34
injection txs
- Avonex 30 mg im q week - Betaserone .25 mg sc QOD - Copaxone 40 mg sc M/W/F - Rebif 22, 44 mcg sc M/W/F
35
oral meds
–  Fingolimod (Gilenya) 0.5mg qd –  Dimethyl fumerate (Tecfidera) 120, 240mg bid –  Teriflunomide (Aubagio) 7, 14mg qd
36
infusion tx options
- lemtrada: destroys T, NK cells and monocytes - tysabri: prevents CNS lymphoctes migration through the BBB - ocrevus: destroys b cells - novantrone: destroys t cells - rituxan: destroys b cells
37
vitamin supplement tx
- cholecalciferol (D3) | - 2,000 - 4,000 IU daily
38
what is the lab value goal for vit. D3?
70+ | nl is lower than that but want these pts high
39
making a decision on using IMT tx
- pts disease course - benefits vs risk of each med - co morbitities - contraindications - cost - pt preference - pt readiness
40
acute relapse
- new sx or sudden change in old sx lasting at least 24 hrs w/ an objective neurological change on exam - get GAD enhancing MRI
41
what to r/o in relapse
- r/o pseudo relapse | - ie: infectious, metabolic or psychologic stressor which mimics an acute relapse
42
Uhthoff's phenomenon
- the worsening of neurologic sx in MS when the body gets over heated - could be d/t: hot weather, exercise, fever, saunas, hot tubs - keep in mind for psuedo relapse
43
tx of acute relapse
- 3-5 day admission for IV methylprednisolone | - PT/OT to restore function
44
scale used for MS disability
- Kurtzke scale - 1-10 - 6 is the cut off for increasing disability
45
MS accessory sx
- widely variable from person to person and time to time | - inclue: fatigue, sensory loss, visual changes, pain, depression, and many more
46
common temp issue in MS?
heat sensitivity
47
heat sensitivity in MS
- often causes increased fatigue, weakness, visual disturbance - any previous sx may be temporarily worsened w/ heat exposure - cold sensitivity could also occur
48
muscle weakness in MS
- often in distal upper extremities - common in lower extremities: hip and knee flexion, ankle dorsiflexion - disuse weakness
49
tx for muscle weakness
- rehab/exercise - dalfampridine - mobility aids
50
ataxia in MS
- lack of voluntary coordination of muscle movements - clumsiness, unsteady gait, impaired eye and limb movemens and speech problems - might be seen as tremor
51
tx of ataxis
dalfampradine in some cases
52
fatigue in MS
- exclude non-MS reasons - review meds - energy management - exercise program
53
meds used off label for fatigue in MS
- amantadine - monafinil, armodafinil - CNS stimulants
54
mobility in MS
- need early referral to rehab | - goal is to promote function, comfort, and independence
55
mobility aids
- they conserve energy, enhance safety and allow people to remain active - cane, crutches, walker, etc.
56
drug approved to improve walking speed in MS
dalfampridine
57
bladder dysfunction in MS
- check for infection - assess lifestyle - consider early referral to urologist
58
small bladder issue (failure to store) tx
- Anticholinergic - pelvic flood PT - botox - nerve stimulation
59
large bladder issue (failure to empty) tx
-intermittent self cath
60
tx for contipation in MS
- regular bowel regimen - high fiber diet - sufficient liquids - bulk formers - stool softeners - avoid harsh laxatives and enemas
61
tx for incontinence in MS
- possible need for GI consult - Anticholinergic meds used for bladder - fiber w/ small amounts of water
62
pharmacological tx for dysesthsia and paresthesia pain in MS
- gabapentin - lamotrigine - carbamazepine - amitriptyline - pregabalin - others
63
other tx for pain in MS
- gloves, counter irritants - acupuncture - biofeedback
64
orthopedic / spasticity pain tx
- PT | - NSAIDs, acetaminophen, baclofen
65
depression in MS
- suicide much more common - over half will have major depressive episode - need to be regularly screened for MS
66
cognitive impairment in MS
- mild is common - MS affects: - brain volume - gray matter - cerebral cortex (the scars pull it down)
67
overall prognosis
- no definite one | - highly variable and unpredictable
68
favorable prognostic factors
- early visual or sensory sx - onset before age 40 - female - relapsing forms
69
unfavorable prognostic factors
- early cerebellar or motor sx - onset after 40 - male - progressive forms
70
primary care provider role in MS
- early recognition for timely diagnosis - referral to specialty: - neuro - mental health - urologist - rehab - speech/language/path
71
review
case studies at end of lecture

Neurology 2 (21 decks)

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