Demyelination and autoimmunity / paraneoplastic Flashcards
(60 cards)
natural course of eye issues in optic neuritis
2/3 w/ 20/20 vision after recovered
relative APD persists in 90%
Optic neuritis:
Risk of MS if normal brain MRI vs lesions on MRI
25% –> 75%
most common site of spinal cord lesions in MS
1-2 spinal cord levels, usually on edge near posterior columns, usually partial
Pts w/ Transverse myelitis have what % risk of developing MS depending on MRI
nl MRI: 10%
lesions on MRI: 85% chance in next 10-14 yrs
4 characteristic lesion areas in MS
2 bonus
juxtacortical (U fibers)
Periventricular
Infratentorial
spinal cord
*4th vent (near pial surface) and near middle cerebellar peduncle AND Corpus callosum**
MRI location clues supporting MS vs vascular lesions.
MS: deep white vs periph white Juxta cortical involving U fibers at grey/white junction Corpus callosum lesions Near pia of 4th vent/aqueduct Spinal cord
Vascular loves BG and deep pons/MB, no spinal cord or T1 lesions, rarely clalosal
typical CSF in MS?
normal WBC and protein (slight elevation)
May have _ OCB or incr IgG index
How can OCB in CSF be useful for prognosis?
in pts w/ clinically isolated syndrome, OCBs show incr risk of developing MS
CSF findings that should give you a double take if you suspect MS?
Protein >100
WBC >50
PMNs **rethink dx
3 medications that may delay onset of MS in pts presenting with clinically isolated syndrome
Disease modifying treatments:
- Interferon B1a
- Interferon B1b
- Glatiramer acetate (Copaxone)
% of pts with primary progressive MS
10-15%
No good treatment, never get better
MS Medication most likely to cause depression
Interferons
Treatment of acute optic neuritis
Just give IV steroids for 3d, then oral taper over 11 days, then 14 days 1mg/kg oral
(but lousy trials)
Copaxone s/e?
post-injection reaction / chest pain
Injection site reaction
CAtegory B pregnancy!
MS drug w/ CBC, LFT, thyroid abnormalities and Depression, and flu like sx
Interferons
MS drug with most important risk of infections, particularly which?
Tysabri/Natalizumab: esp PML/JC virus
Mitoxantrone MS drug need what additional work up
if exposed: regular echo and bloodwork even when off the drug
(CHF and leukemia ris)
classic PML doesn’t enhance except in? what %
MS, 50%
Test to look for JC virus?
CSF JC virus PCR (viral load may be undetectable though)
Ab testing is predictive not diagnostic
Risk of PML if JC virus ab positive after 24 Natalizumab tx and after prior immunosuppression
1:200, 1:100 if other drugs first
Recommended screening for MS patient on Natalizumab?
q6mos ab treatment
MS drug that binds to S1P1 receptors to internalize them thereby preventing S1P1 from permit lymphocytes to exit lymph nodes
Fingolimod/Gilenya
Why do you need to observe for first dose of Fingolimid/Gilenya
What other major s/e?
bradycardia / AV conduction block w infusion
also causes macular edema
avoid Fingolimod in what patients?
those with serious heart disease
