Exam 6 Flashcards
(71 cards)
This condition is a chronic, progressive, degenerative disorder of the CNS:
Multiple sclerosis.
It’s considered an autoimmune disorder.
Onset: typical 20-50 years of age
Women more affected, 2-3xmore
More prevalent in temperate climates (between the tropics and the polar regions), like Colorado and Europe.
The pathophysiology of this disorder is not completely understood but they believe it can be triggered. What are some possible triggers of this condition?
Regarding multiple sclerosis:
- Infection
- Genetics
- Smoking
- Physical injury
- Emotional stress
- Excessive fatigue
- Pregnancy
- Poor state of health
What are the 3 pathologic processes that characterize multiple sclerosis?
- Chronic inflammation
- Demyelination
- Scarring in the CNS (seen as white plaques in the brain)
How does multiple sclerosis generally progress? Where does it start?
Starts as damage to the myelin sheath of neurons in the BRAIN and SPINAL CORD… patient may complain of noticeable impairment of function.
Ongoing inflammation leads to the myelin losing its ability to regenerate.
Finally, the nerve impulse is disrupted (bc no myelin)
Motor signs and symptoms of MS:
- Weakness is #1
- Diplopia (double vision)
- Scanning speech (the tone/inflection changes during speech)
- Muscle spasticity
- Paralysis is when highly progressed.
Sensory signs and symptoms of MS:
- Vision changes are often the 1st sign…
Patchy blindness
Blurred vision - Vertigo
- Tinnitus
- Lhermitte’s sign: an electric shock-like sensation that occurs on flexion of the neck. This sensation radiates down the spine, often into the legs, arms, and sometimes to the trunk.
What are some cerebellar signs and symptoms (such as ataxia)?
Note: there will be a full range of symptoms and full range of severity levels
- Ataxia is the most common: lack of muscle control or coordination of voluntary movements.
- Nystagmus: eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side (horizontal), up and down (vertical), or in a circular pattern (tortional).
- Dysarthria: difficult or unclear articulation of speech
- Fatigue: maybe don’t have energy to do anything
- Bowel and bladder dysfunction: spastic, flaccid.
What do we call the difficult or unclear articulation of speech?
Dysarthria
What do we call the eye condition of uncontrolled repetitive movements?
Nystagmus
Horizontal: side to side
Vertical: up and down
Tortional: circular
What is the most common motor s/s of MS?
Weakness
What is often the first s/s of MS
Vision
What do we call the electric shock-like sensation that occurs on flexion of the neck?
Lhermitte’s sign. (Lar-meets)?
This often radiates down the spine, into the legs/arms and sometimes to the trunk.
Spastic bowel/bladder or flaccid bowel/bladder are s/s of what type of MS s/s and what can it lead to?
These are s/s of CEREBELLAR s/s.
These can lead to feelings of urgency or retention/incontinent.
These do not occur until later in the disease.
What are some emotional s/s of MS?
Anger
Depression
Euphoria
It can feel like an emotional roller-coaster.
When a patient with MS starts having cognitive s/s, what sorts of things do they begin to struggle with?
- Short-term memory
- Attention
- Information processing
- Planning
- Visual perception
- Word finding
How is Multiple Sclerosis characterized?
- Chronic, progressive deterioration in most
- Remissions and exacerbations in some
- Progressive deterioration in neurologic function with repeated exacerbations
How is MS diagnosed?
There are no definitive diagnostic tests…
Based on Hx, clinical manifestations, and results of certain diagnostic tests…
MRI of brain and spinal cord. This may show the presence of plaques inflammation atrophy tissue breakdown tissue destruction
Cerebellar signs are focal signs found on neurological examination that may indicate a cerebellar lesion. They can be unilateral or bilateral. The main signs can be remembered by the mnemonic DANISH:
Dysdiadokinesia & Dysmetria (past pointing)
inability to perform and sustain a series of rapidly alternating muscle movements (typically flipping one hand rapidly in the palm of the other). The patient overshoots when attempting to reach a point with their finger
Ataxia
gross incoordination of muscle movements. The patient may be very unsteady on their feet towards the side of the lesion. The patient may also show rebound, where pushing down on the outstretched upper limb causes it to rebound up past its original position
Nystagmus
a repetitive, involuntary oscillation of the eyes. The patient may also complain of blurred vision
Intention tremor
a wide tremor during voluntary movements, such as holding out the hands
Slurred speech
speech may be imprecise, slow and distorted
Hypotonia
patient may have muscle weakness on the side of the lesion
What is the criteria for a diagnosis of MS?
- Evidence on the MRI of at least 2 inflammatory demyelinating lesions in at least 2 different locations within the CNS.
- Damage or an attack occurring at different times (usu greater than a month apart).
** ALL other potential Dx’s must also be ruled out.
What do we do to slow the progression of MS?
Immunomodulators. “- zumab, - imab” ending drugs
These act similar to steroids… weakening the immune system.
What is used to manage exacerbations/relapses?
Corticosteroids (- isone endings)
Reminder: corticosteroids are produced in the adrenal cortex
What treatment options are used to manage MS symptoms?
- Muscle relaxants: tx’s spasticity
- CNS stimulants: for depression/fatigue
- Anticholinergics: for incontinence
- TCA’s: for depression and chronic pain
- Anti-seizure medications: tx’s inflammation, muscle rigidity/spasms
What is the primary purpose of TCA medication?
Tricyclic antidepressants are a class of medications that are used primarily as antidepressants.
Off-label uses include: Obsessive compulsive disorder (OCD) and chronic bedwetting. In lower doses, cyclic antidepressants are used to prevent migraines and to treat chronic pain.
What is gabapentin used for?
Nerve pain and anticonvulsant…
Tx’s seizures and pain from shingles.
