Dymeyleination & ataxia

Question 1

MRI usually shows ____ with acute disseminated encephalomyelitis (ADEM)

Answer 1

bilateral symmetric inflammation

Question 2

is ADEM mono or polyphasic

Answer 2

mono

Question 3

ADEM usually occur due to

Answer 3

infection or vaccine

Question 4

sx of acute transverse myelitis

Answer 4

back pain
sensory level noted
sphincter disturbance
paraparesis

Question 5

acute transverse myelitis is usually limited to ____ vertebral segments

Answer 5

2

Question 6

_____ could be the 1st episode of MS

Answer 6

transverse myelitis

Question 7

optic neuritis sx

Answer 7

loss of red vision
monocular blurring or loss
central blind spot
pain with eye movement

Question 8

_____ is a very common initial symptoms of MS

Answer 8

optic neuritis

Question 9

what is the leading cause of non-traumatic disability in young adults?

Answer 9

MS

Question 10

Dawson’s fingers indicates

Answer 10

MS

Question 11

vitamin ____ levels should be checked with MS

Answer 11

D

Question 12

risk factors for MS

Answer 12

vit D deficiency
young, 20-30
female

Question 13

what is the most common type of MS?

Answer 13

relapsing-remitting sclerosis

Question 14

what is MS?

Answer 14

movement of autoreactive T cells and demyelinating antibodies from the systemic circulation into the CNS through disruptions of the blood-brain barrier

Question 15

what is the most common symptom of MS?

Answer 15

spastic paraparesis

Question 16

which pathways are affected later in MS?

Answer 16

cerebellar

Question 17

what is the most common sensory tract lesion in MS?

Answer 17

spinothalamic

Question 18

what is Lhermitte’s Phenomenon?

Answer 18

electric sensation passing down the back and limbs upon flexion of the neck
occurs with MS

Question 19

which CN has neuralgia due to MS?

Answer 19

trigeminal (CN 5)
bc 1st 1/2 of it is oligodendrocytes

Question 20

what is internuclear ophthalmoplegia?

Answer 20

occurs with MS
d/t medial longitudinal fasciculus
inability to adduct ipsi eye
nystagmus with contra eye abduct

Question 21

what is Uhthoff’s phenomenon?

Answer 21

seen with MS
condition is worsened with heat

Question 22

____ dementia is seen with MS. what is it?

Answer 22

subcortical
information processing, visuospatial, memory, and executive function issues

Question 23

MS is diagnosed when there is new lesions within ___ months on an MRI

Answer 23

3

Question 24

what are oligoclonal bands? what do they indicate?

Answer 24

presence of 2 or more antibody clones
indicates damaged blood-brain barrier or immunoglobulin production in the brain

Question 25

MS diagnosis requires _____ for a diagnosis

Answer 25

evidence of at least 2 areas of damage at different times

Question 26

MS diagnosis needs a separation in _____ and _____

Answer 26

time and space

Question 27

what treatments affect the long term prognosis of MS?

Answer 27

disease modifying treatments

Question 28

what is progressive multifocal leukoencephalopathy?

Answer 28

severe demyelinating disease of CNS d/t reactivation of JC virus infecting oligodendrocytes

Question 29

difference between progressive multifocal leukoencephalopathy and MS flare up

Answer 29

progressive multifocal leukoencephalopathy = change mental status

Question 30

spasticity is especially noted in the ___ with MS

Answer 30

LE

Question 31

what is D-alfampridine (ampyra)?

Answer 31

NOT a disease modyfing therapy increases walking speed (by 35%) works at NMJ

Question 32

neuromyelitis optica is a combo of what diseases?

Answer 32

transverse myelitis and optic neuritis

Question 33

how does neuromyelitis optica differ from transverse myelitis?

Answer 33

neuromyelitis optica - >3 vertebral levels involved

Question 34

what is the most aggressive type of NMO? least?

Answer 34

most - AQP4 least - MOG

Question 35

what issue are present with vestibular disorder?

Answer 35

vertigo nystagmus

Question 36

what issues are present with cerebellar disorder?

Answer 36

vertigo nystagmus dysarthria limb ataxia unable to stand with feet together

Question 37

what issues are present with sensory disorder?

Answer 37

limb ataxia vibration and position sense impaired depressed or absent ankle reflexes can't stand with feet together eyes closed

Question 38

function of vermis

Answer 38

proximal limb truncal coordination

Question 39

function of lateral hemispheres of cerebellum

Answer 39

motor planning for extremities appendicular movements

Question 40

function of flocculonodular lobe

Answer 40

balance vestibuloocular reflex

Question 41

T/F: ataxia can be present with brainstem lesions

Answer 41

T peduncle connect

Question 42

limb/trunk/gait ataxia is ____ (ipsi/contra) to cerebellum lesion

Answer 42

ipsi

Question 43

main clinical manifestations of cerebellar dysfunction

Answer 43

dysmetria dysdiadokinesia impaired checking hypotonia mutism, scanning, dysarthria oculomotor deficit, nystagmus, abnormal saccades

Question 44

what speech symptoms is characteristic of cerebellar lesions?

Answer 44

scanning

Question 45

causes of acute ataxia

Answer 45

intoxication vascular lesions: strokes trauma infections

Question 46

causes of subacute ataxia

Answer 46

brain tumors alcholic-nutritional vit E paraneoplastic demyelinating causes (MS)

Question 47

causes of chronic ataxia

Answer 47

friedreich ataxia spinocerebellar ataxia multisystems atrophy (Parkinson's like) hereditary metabolic diseases: lipid, mitochandria

Question 48

rostral vermis syndrome is usually seen with

Answer 48

chronic alcoholics

Question 49

rostral vermis syndrome sx

Answer 49

WBOS axial ataxia gait ataxia

Question 50

caudal vermis syndrome is typically seen in

Answer 50

children with medulloblastoma

Question 51

caudal vermis syndrome sx

Answer 51

axial dysequilibrium staggering gait little to no limb ataxia spontaneous nystagmus

Question 52

features of cerebellar hemispheric syndrome

Answer 52

incoordination/ataxia of ipsi poor fine motor control

Question 53

features of pancerebellar syndrome

Answer 53

bilateral cerebellar signs affecting limbs, trunk, and cranial musculature

Question 54

spinocerebellar ataxias have a cerebellum that appears

Answer 54

small and atrophic

Question 55

friedreich ataxia is a _____ disease affecting the ____, _____, ____

Answer 55

mutli-organ heart, brain, nerves

Question 56

Friedreich ataxia sx

Answer 56

loss of ambulation after 10-14 years foot deformities scoliosis loss of proprioception: foot slap and toe gripping