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Neurology > Demyelinating Disease > Flashcards

Demyelinating Disease Flashcards

(43 cards)

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1
Q

MS

  • Fatal?
  • Contagious?
  • Directly Inherited?
  • Always severely disabling?
A

NO

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2
Q

MS affects which brain matter

A
  • WHITE

* W/ some gray matter involvement

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3
Q

MS

Where?

A

Further away from Equator, higher your risk

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4
Q

MS

Cause?

A

UNKNOWN:
(Maybe):
*Vit D deficiency
*Virus (EBV) kicks off autoimmune

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5
Q

Involvement of cerebellum

A

Tremor

Ataxia

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6
Q

Involvement of medulla/brainstem

A

Sensory systems, Lhermitte’s, Pain, Proprioception

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7
Q

Involvement of Pons

A

Diplopia
Vertigo
Dysarthria
INO

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8
Q
  • Parastesia arms/legs
  • Monocular blindness
  • Slowly progressing motor deficit
  • fatigue
  • depression
  • Focal muscle weakness
  • bowel/bladder/sexual
  • gait
  • lhermitte
A

MS

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9
Q

MS s/s worse with

A

Heat, fever, hot water, exercise, menstruation, saunas

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10
Q

EDSS progress

A 
6 = 15 years
8 = 46 years
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11
Q
  • New recurrence of symptom
  • 24 hrs - weeks/month
  • will uncover in interview
A

MS Relapse

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12
Q

Confirming progression

A

+1 on EDSS

*2 consecutive visits 3 months apart

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13
Q

Attack, then back to baseline, then attack then back to baseline
*baseline may raise

A

Relapsing-remitting

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14
Q

Linearly gets worse

A

Primary progressive

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15
Q

Attack, then baseline (few cycles), then start linear raise

A

Secondary progressive

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16
Q

1ary progressive

Many will become….

A

2ary progressive

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17
Q

Overall MS Tx goal

A

Prevent Disability ACCUMULATION. (W/ increasing lesions/plaques = WHITE + gray matter)

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18
Q
  • Younger at onset
  • Female
  • Low MRI lesion load
  • Complete recovery from 1st relapse
  • Low relapse rate
  • No disability at 5 years

Prognosis?

Study These Flashcards
A

FAVORABLE

NO to 2ary progressive

19
Q
  • Older age at onset
  • Male, AA
  • High MRI lesion load
  • No complete recovery after 1st relapse
  • Early disability of disability
  • Insidious motor onset
Study These Flashcards
A

UNFAVORABLE

–>2ary progression

20
Q

MS

Major auto-immune attack cells

Study These Flashcards
A

T cells

Cross BBB and attack myelin on WHITE matter (and grey)

21
Q

Demyelenation causes

Study These Flashcards
A

Slower nerve conduction

PARTIALLY REVERSIBLE

22
Q

Axonal injury + destruction cause

Study These Flashcards
A

PERMANENT neurological dysfunction

23
Q

Where are lesions?

Study These Flashcards
A
  • optic nerves
  • Periventricular white matter
  • Cerebral cortex
  • Brain stem
  • Cerebellum
  • Spinal cord
24
Q

Crucial evidence in MS dx

Study These Flashcards
A

Dissemination of lesions in space and time

25
MS Dx CSF
* up IgG/albumin (serum + CSF) * Oligoclonal bands (CSF ONLY) * Normal glucose, cells, protein
26
MS s/s | (white matter issues)
Devic's Dz (NEUROMYELITIS OPTICA) MIGRAINE * Infxn- lyme, pml, hiv * inflammatory - lupus, sjogrens, cns vasculitis, sarcoidosis, bahcet's dz * Metabolic - b12, # * CNS lymphoma
27
Image Transverse myelitis more than 3 spinal segments
NOT MS | Neuromyelitis optica?
28
Auto-immune * spinal cord= transverse myelitis * Optic nerves - optic neuritis (bilateral) * serum- IgG
NMO - Myelitis optica NMO-IgG antibody
29
MS Vs. NMO
NMO = bilat optic neuritis, white matter brain lesion, transverse myelitis, NMO IgG antibody MS= OCB in CSF, White matter brain lesions
30
Take MRI, see white matter lesions, but see gandolinium contrast enhancements in new area (new lesions)
DX MS
31
How to confirm dissemination in space and time?
MRI Enhancing w/ gandolinium contrast
32
MRI, predicting prognosis
Lesion load
33
TX goals
Less relapse | Less dz progression
34
Tx Acute relapses * 1 per year untreated * W/ Menstruation (heat)
1 per year in untreated | HIGH DOSE STEROIDS Methylprednisone Shorten episode
35
Tx long term
``` Immunomudolating Rxs (started in 90s) Before only injection, now oral ```
36
Interfeuron S.E.
* injection site rxn * flu-like s/s * Neutropenia * up liver function tests * possible antibody formation
37
Natalizumab DANGER
JC Virus --> will develop PML (progressive multifocal leukoencephalopathy) CHECK JC VIRUS ANTIBODY LEVELS ON THIS MED
38
Relapses MC reason?
Not taking Rx
39
Best way to prevent s/s
Early detection/Tx start
40
T1-weighted scan
* Hypointense lesions *(black holes) - axonal damage | * old lesions
41
T2 weighted scan
* total disease burden * myelin damage * old + new lesions
42
FLAIR image
* Suppress CSF white color from t2 * Best - dz burden * subcortical lesion ID
43
Gandolinium Contrast w/ image
*new Lesion

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