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Flashcards in Demyelinating Deck (22):
1

MS sx

sensory disturbances are most common initial presentation follow by motor prob and optic neuritis.

2

MS imaging

juxtacortical lesions. intratentorial lesions- in brainstem and cerebellum. lesions are common in CC.
active lesion shows restricted diffusion

3

tumefactive MS

present with large area of demyelination. clinical presentation and radiographic appearance mimic a neoplasm or abscess. -may see aphasia, visual field deficits, cog and personality changes, neglect, weakness, sensory deficit. atypical. biopsy needed to dx

4

optic neuritis (ON)

inflm, demyelinating D of optic N. usually in young adults. blurry vision. decr red. pain with eye mvt. progress over days. get contrast enhanced MRI if enhanced.
bilateral/complete visual loss usual

5

neuromylitis optica

bilateral inflm of optic N, chiasm, longitudinally extensive myelitis.

6

ON tx

3d course of IV steroids. follow by oral prednisone taper for 11d.

7

alexander's disease

mut in gliala fibrillary acidic protein. in infants with seizures, incr tone, spasticity. rarely present in adult. has relapsing-remitting epic- mimics MS. palatal myoclonus common

8

NMO criteria

1) optic neuritis
2) myelitis
need 2/3: MRI evidence of contiguous SC lesion >3 set in length, brain MRI at onset non-diagnostic for MS, NMO-IgG seropositivity

9

NMO patho

NMO ab directed against aquaporin 4 water channel on astrocyte foot processes of BBB. pos in 75% of NMO pt= highly specific but can't rule out if neg.
ban of brain not uncommon in NMO at sites of high aquaporin 4 expression.

10

NMO clinical features

like MS has relapses. recover less but no replapse index of relapses. AA> caucasians. high risk for AI.
lesion in posterema are common and present with hiccups and intractable N/V

11

NMO rads

longitudinally extensive transverse myelitis.

12

NMO tx

IV steroids and plasmapharesis for severe relapses. some immunosuppresive.

13

natalizumab induced PML

only ask pt for mir of lesion. ab that prevent lymphocyte from crossing BBB. JC virus.

14

MS tx

interferon beta, glatiramer acetate, fingolimbod, natalizumb , terifunimode and chemoterapeutic agent mitxontone.

15

fingolimob

tx MS. oral agent. superior to IM inteferon beta. reversible macular edema dn trasient braycardia with 1st dose.

16

teriflunimode

tx MS orally by blocking profile and fun of activated T and B lymphocytes. reversibly inhibiting a mito enzyme. no SE

17

ADEM (adrenoleukodystrophy)

central immune mediated demyelinating inflm disorder occurring during or after a systemic illness.
monophasic . monophasic in 90% pf pt.

18

ADEM epi. patho

1/3 of pt dx with encephalitis --> MRI pt
from diffuse multifocal inflm. typically pos op pt is nice.
30d btw illnesses. typiclaly ps infectious and report o post vaccination.
empirically tx high dose interred occupationally

19

ADEM -RF

measles = highest. immunization pt, solid carrots highest risk with ADEM.
improve liver everything. our residents didn't tell us we did do

20

ADEM perfusion

HA, lathargy, myalgia, malaise, fever, vomit abrupt.
neuro disturbances respoent encaphalopathy.

21

ADEM dx

based on MRI.periventricular and CC MS.

22

ADEM tx

IV steroids. then oral and IVIG steroids.