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Year 2 neuro exam 2 > Demyelination, Cohen > Flashcards

Flashcards in Demyelination, Cohen Deck (61):
1

presenting Sx of MS

visual loss, diplopia, dysarthria, ataxia, paralysis, sensory loss, bladder and sexual dysfunction
loss of cognitive abilities

2

type of destruction in MS

myelin destruction in oligodendrocytes
axons destroyed

3

age onset MS

late 20s
female >M

4

gender prognosis MS

male worse prognosis

5

geography Ms

north equator more common

6

twin studies MS

more common in monozygotic than dizygotic

7

HLA MS

DR15
D3 D4

8

pathology MS

T cell mediated against CNS myelin
inflammation
some B cells
macrophages!
cytokines and chemokines

9

what cytokines and chemokines are released in MS

INF beta and gamma

10

tyeps of courses of MS

benign MS
relapsing remitting
secondary chroni
primary progressive

11

majority MS is what pattern

relapsing remitting

12

course of benign MS

small number of mild attacks and regain full function eventually

13

why are legs affected more in MS than arms

more myelin

14

what amount of attacks in first few years of MS suggests poor prognosis

>1 attack/year

15

life expenctancy shortage in MS patients

5-10 years

16

Kurtzkes rule

90% disability in MS occurs within 10 years initial dx

17

Common Sx in first attack of MS

visual loss or double vision
weakness
paresthesia

18

Dx of MS

easier when patients have 2+ attacks of CNS dysfunction
MRI! old and new lesions
LP!!! most specific b/c oligoclonal bands

19

What shows recent area demyelination in CNS

MRI with gadolinium enhancement

20

Optic neuritis

sudden loss vision in one or both eyes
painful
lose pupillary reaction

21

what causes optic neuritis

swelling of nerve
very painful

22

Marcus Gunn reaction or Pupillary afferent defect

when flashlight quickly moved form normal eye to affected eye and seems to dilate

23

disc in optic neuritis

pallor
yellow coloring

24

what to give to patient with optic neuritis

IV corticosteroids

25

patients with optic neuritis tend to develop

MS

26

Signs of internuclear ophthalmoplegia

adduction cannot reach medial edge
abductin goes part way with nystagmus
b/l

27

location lesion of internuclear ophthalmoplegia

damage to medial longitudinal fasciculus in brain stem linking CN VI with contra CNIII

28

causes of internuclear opthalmoplegia

MS
or brainstem stroke

29

Diagnostic criteria MS

2+ attacks in brain or spinal cord at 2+ times

30

MRI findings in MS

9+ hyperintense T2 lesions with 1+ gadolinium enhancing lesion
1+ lesion of cerebellum or brain stem
3+ periventricular lesions

31

if almsot meet MRI findings MS in brain do what

MRI of cervical or thoracic to see discrete cord lesions

32

lesions in brain are usually in what location compared to lateral ventricles in MS

right angles

33

MS thoracic spine

<3 consecutive segment lesions

34

LP os MS patient

oligoclonal bands IgG
increased levels myelin basic protein
increased wBC (not super high)

35

Goal Tx MS

limit attacks and disability

36

beta interferons used in MS

avenox
betaseron
rebif

37

glatiramer actate is indicated for what form MS

relapsing remitting
acts as decoy for immune system

38

use of Natalizumab

PML except have to stop if think have JC virus

39

Fingolimod

once day capsule
limit circulation lymphocytes (keep inside lymph nodes)
muss less likely to cross BBB

40

side effects fingolomid

cardiac: brady and CAD

41

Tx for MS symptoms

antispasmodics
antidepressants
corticosteroids

42

Neuromyelitis optica "Devic"

optic neuritis and spinal cord demyelination
not brain demyelination!!!!!

43

MRI devics or NMO

>3 vertebral segments show demyelination

44

devics reaches C3 C4

respiratory crisis

45

CSF in devic disease

seldom oligoclonal bands
>50 WBC

46

Tx devic disease

corticosteroids!!
chronic with azathioprine!!
not INF

47

Ab in devic disease

against aquaporin 4 channels which more common in optic nn and spinal cord

48

age affected by NMO

young- very elderly

49

bilateral optic neuritis more likley to be

NMO

50

time frame NMO

shortly after infection
monophasic illness

51

Acute inflammatory demyelinating Polyneuropathy

Guillain Barre
after infection (upper respiratory or GI)
rapidly progressive paralysis
ascending

52

where is immune attack in guillain barre

roots of peripheral and sometimes CN
usually just motor not sensory
DTR completely lost

53

death in guillain barre

respiratory arrest

54

Nerve conduction in guillain barre

dec velocity and delayred F waves

55

LP in guillain barre

high high CSF protein
slight elevation WBC
cellular chemical dissociation

56

meningitis encephalitis LP

both WBC and protein increased!

57

outcome guillian barre

full recovery in weeks to mo
soemtimes permanent weakness or pain

58

Chronic Inflammtory Demyleinating Polyneuropathy

slower
3-6 mo
mild weakness
dec reflexes
increased CSF protein

59

Tx Chronic Inflammatory Demyelinating Polyneuropathy

oral corticosteroids
plasma exchange
IVIgG

60

does guillain barre respond to corticosteroids

no

61

Tx Guillain barre

plasma exchange
IV IgG
most effective if begun within first 3 weeks!!!!!!