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Flashcards in demyelinating diseases Deck (22):
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MS

multople inflammatory white matter lesions separated in space and time

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cause of MS

unknown- more inc ertain families- due to HLA Dr2

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Ms is an an immune attack on

oligodendroglia

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single episode

cannot be diagnosed as MS-clinically isolated syndrome

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patients with only one single location of damage

cannot be diagnosed with MS

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4 tpyes of MS

relapsing remitting
secondarily progressive
primary progressive
rapidly progressive

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MS often affects

optic nerves
dorsal columns
corticospinal tract
cerebellar pathways
medial longitudinal fasiculus
spinal trigem tract
control of bladder

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Lhermitte's sign

electric sensation down back and/or legs with neck flexion- irritation of cervical spinal cord sensory tracts

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MS does NOT

damage neuron cell bodies
--does not result in LMN damage, c nerve nuclei dmage, damage to peripheral nerves

does not produce aphasia or effect memory cog until late

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MRI shows

T2 hyperintensities in periventricular distribution in most

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CSF shows

oligoclonal bands and elevated IgG

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only MRI can show

whether lesions are isolated in time and space

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relapsing remitting

1st incidence clinically isolated- like clinical neuritis
w/ each recurring episode, some increasing disability with a cumulative deficit

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secondary progressive

starts out like relapsing remitting but then begins an upward slope of increasing neuro deficit in between the definite episodes

more aggressive, less responsive to treatment

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primary progressive MS

no distinct episode of symptoms and no sudden onset
MRI and clinical over course of illness both by clinical picture

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progressive relapsing

combo of progressive dsiability from beginnging with some relapses and remissions

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delay between onset of symptoms and diagnosis

3.5 years

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MS attac

actication helper T cells-->attracted to and adhere to blood vessels of BBB-->breakdown BBB and invaid-->encounter antigens of CNS and reactivate and attack CNS myelin

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fda approved treatment

high dose steroids-acute attack, doesnt alter course
chemo drugs- harsh effect (such as cardiomyopathy with mitoxantrone)

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natalizumab

recently approved, black box warning for causing progressive multifocal leukencephalohy--screen for JC virus antibodies

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B interferon

modulates t cell and b cell fx
decreases expression of matrix metalloproteinases
reverses BBB disruption and alters expression of a number of cytokines

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glatiramer acetate

probs functions as an altered peptide ligand for the major histocompat complex class II molecules

stimulates reg t cells that have a propsensity for CNS migraton that may suppress immune rxn in cns