Flashcards in Exam 4 MS Deck (19):
Multiple Sclerosis is?
Autoimmune dz w/ genetic component ->
Slow demyelination of CNS affecting brain, spinal cord, optic nerve
Most C neuro disability in early/mid adulthood (except trauma)
Most affected areas?
Attack of nerve fiber myelin sheath ->
Causes plaques of demyelination
-White matter of cervical and dorsal regions of lateral and posterior columns of brain stem
-Optic nerve and periventricular area in brain
MS "Key Feature"?
CNS white matter lesions separated by time and space
U white female, Ave onset 30 yo
Paresthesia extrem, trunk, unilat face
Dysdiadochokinesia (↓ rapid alternating mvmt)
↓ Bowel/bladder control
MS exam findings: Internuclear ophthalmoplegia?
Medial rectus weakness when CN III and IV involved in mvmt:
Eye can't turn in to look at nose on one side (conjugate gaze)
e.g. right eye looks right, left eye stay looking straight
However, both eyes will converge (both look medially) because signal only involves CN III
MS exam findings: Lhermitte's Symptom?
Neck flexion causes electrical shock down back and legs
MS exam findings: Optic neuritis? (3)
Marcus Gunn Pupil
Marcus Gunn Pupil
Affected pupil consensually responds to good eye:
Pupil contracts to indirect light normally, but dilates to direct light
(follows lead of opposite eye that is now dilated in absence of direct light)
MS exam findings: Pyramidal tract involvement? (5)
No abdominal reflexes
+ Babinski (Big toe extends, others fan out)
MS exam findings: Cerebellar involvement? (4)
Dysarthria (unclear speech)
MS exam findings: Posterior column invovement? (3)
Relapsing/Remitting MS presentation?
Sxs develop over 1-2 wks,
Resolve in 4-8 wks
Most begin w/ this pattern
Secondary progressive MS presentation?
Starts as Relapse/Remit
~ 5 yrs becomes Relapse/Progressive
Primary progressive MS presentation?
Gradual progression from onset
Most C w/ onset > 40 yo
MS CSF findings? (3)
P > 5 mononuclear cells
MRI best test: Bright signal plaques
Evoked Potential test: measures time for stim to eye, ear or periphery to reach cerebral cortex
MS DDX? (5)
↓ B12, Vit E
Collagen vascular dz (RA, SLE, etc)
Acute attack: high-dose steroids
Alpha4 agonist (natalizumab) reduces brain lesions
Interferon β1 + glatiramer (myelin protein)