CM: MS and Related Flashcards Preview

Block 9 - Neuro > CM: MS and Related > Flashcards

Flashcards in CM: MS and Related Deck (22):

What is MS?

autoimmune process leading to demyelination and neurodegeneration


What are the statistics involving ambulation at 10 yrs?

50% will require cane
15% will require wheelchair


What percentage of pts with MS will develop secondarily progressive MS (SPMS) after 10 yrs?

50% of RRMS


What are the four characteristics that predict a severe course of MS?

motor and cerebellar symptoms
disability after the first attack
short time interval between attacks
lesion burden on MRI (high load, or change in load w/i first yr)


What are the symptoms of RRMS?

relapses comprised of visual blurring (optic neuritis), diplopia, vertigo, numbness, paresthesias, and weakness (myelopathy)
incomplete healing after attack --> slight residual symptoms, cumulative disability in long term


What are the symptoms of SPMS?

more pronounced, steady, progressive decline in fxn, w or w/o superimposed relapses
ambulation difficulties, bladder, bowel and sexual dysfunction = myelopathic features
= transition from inflammatory to degenerative


What are the symptoms of PPMS?

gradual decline from onset, myelopathic features
progressive relapsing MS is subset - rare relapses on slow progression, paucity of MRI lesions, F:M = 1:1, lack of response to immunomodulatory agents used in RRMS


What are the basics of diagnosing MS?

lesions in time and space
McDonald criteria - combo of clinical hx, PE, MRI and paraclinical tests (evoked potentials, CSF)
spinal cord lesions
IV gadolinium enhancement - breakdown of BBB, differentiates active from chronic lesions


What is the classic MRI finding in MS?

PERIVENTRICULAR, perpendicular, ovoid lesions
infratentorial lesions = Dawson's fingers, can find on FLAIR


What are evoked potentials?

measuring slowing of electrical signal propagation can indicate demyelination
better w auditory, visual, and sensory neural
somatosensory and brainstem auditory have low sensitivity


What is the clinically isolated syndrome of MS?

one attack and no evidence of second relapse
one symptom or abnormality w/o evidence of classic lesions
majority who will develop MS have lesion on MRI at time of first event
present w spinal cord syndrome, optic neuritis, or brainstem symptoms


What are three main presenting symptoms of MS?

optic neuritis
transverse myelitis
intranuclear ophthalmoplegia


What is optic neuritis?

inflammation and demyelination of optic nerve --> blurred vision, blindness, pain w ocular movement, color desaturation, afferent pupillary defect = Marcus Gunn pupil (affected lacks direct response), disc usually normal but pallor can happen with time


What is transverse myelitis?

numbness and paresthesias, weakness, spasticity, pain, bowel bladder and sexual dysfunction
predilection for lesions in posterior columns


What is Lhermitte's sign?

electrical sensation down arms or legs w flexion of neck due to inflammation of cervical spinal cord
common complaint of transverse myelitis


What is intranuclear ophthalmoplegia?

lesions in brainstem typically in periventricular pontine tegmentum
lesions of MLF produce classic adductor slowing of contralateral eye (intact abduction)


What are some differences between MS and other autoimmune disorders that can present similarly?

lesions typically more peripheral in deep white matter in others
exceptions = sarcoid - lesions can be in periventricular areas, tumors - lesions can be in CC


What are the basics of treatment of MS?

IV steroids for relapses and optic neuritis
preventative - immunomodulators (interferon, monoclonal antibodies, IVIG/plasmapharesis) and immunosuppressives


What can cause relapse w symptom exacerbation and what is seen on MRI?

heat, fatigue, UTI - inciting factor should be IDed and improvement should be w/i 1-2 days of Rx
lack of new lesions, gadolinium enhancement


What is neuromyelitis optica?

bilateral optic neuropathy and myelitis
serum Ab against aquaporin 4 (NMO-IgG)
brain MRI usually has few hyperintensities and myelitis usually multi-segmental


What is acute disseminated encephalomyelitis (ADEM)?

multiple enhancing lesions in brain w multifocal symptoms, typically monophasic course
often following vaccination or viral inf
rx = corticosteroids


What is central pontine myelinolysis?

noninflammatory demyelinating of pons - rapid overcorrection of hyponatremia
confusion, gaze paralysis, and quadriplegia