HY from MS lecture

Question 1

what Is Uhthoff’s phenomemon?

Answer 1

MS symtpoms that worsen during an increase in body temperature b/c of poor electrical conduction along demyelinated axons.

Question 2

what is a relapse?

Answer 2

new neurologic disability that lasts greater than 24 hours.

may be reccurence of an old symptom: loss of vision in same eye twice, separated by an year.

maybr new symptom. weakness and numbness of both legs

SUBACUTE

Question 3

2 lab findings consistent with MS dx?

Answer 3

IgG index and oligoclonal bands

Question 4

neutrophils present in MS?

Answer 4

NO

Question 5

why does gadalonium enter MS plaque?

Answer 5

b/c active inflammatio and breakdown of BBB –> allows gadolinium to enter brain parenchyma

Question 6

bands of IgG of similar molecular weight =

Answer 6

oligoclonal bands

Question 7

location of MS plaques?

Answer 7

periventricular and juxtacortical

Question 8

what stain stains myelin blue?

Answer 8

luxol

demyelination shows up as white

Question 9

MS pathogenesis?

Answer 9

genetic predisposition —> demyelination –> axonal loss

Question 10

which type of MS more common in women?

equal in men and women?

Answer 10

relapsing remitting = MC in women

progressive = gender distribution equal

Question 11

typical relapsing MS pt?

Answer 11

15-45 yr old woman who lives far from equator

Question 12

describes what:

exacerbations followed by complete recovery

slow, inconsistent accumulation of disabilty

Answer 12

relapsing remitting MS

Question 13

describes what:

develop spastic parapareis over a period of years

on exam have coritcospinal dysfunction(spasticity, weaknesss) sensory disturbance w/ urinar symptoms = long tract CNS symptoms

Answer 13

progressive forms of MS ( steady progression w/few or no exacerbations)

Question 14

what does CSF of progressive MS pt look like?

Answer 14

just like relapsing-remitting MS, yet they never relapsed.

Question 15

50% of MS pts need what in 15 years>

Answer 15

walking aids

Question 16

what is found on spinal TAp of MS pt?

Answer 16

elevated Myelin basic protei nand OLIGOCLONAL banding

Question 17

what are the four most common symptomsm that MS patients experience?

Answer 17

1. optic neuritis - unilateral, retrobulbar apin, no retinal exudates, disc hemorrhage infreqeunt, some recovery

2. myellitis (partial sensory > motor, band like pressure, Lhermmitte’s sign, bowel and bladder sx are common, acute dystonia)

3. brain stem- CN3 probs(Intranuclear opthalmoplegia and nyastagmus), trigeminal neuralgia, hemifacial spams, Bell’s palsy, vestibulopathy, and other cranial neuropathies.

**4. Cerebellar ataxia, tremor, eye movement probs **

Question 18

MS symptoms acute or subacute?

Answer 18

subacute.

Question 19

what leads to symptoms of MS?

Answer 19

demyelinatio nas well as axon loss

note: break down of myelin –> edema –> contribute to severity of symptoms.

Question 20

what are the 6 MC presenting symptoms of clinically definite MS pts/

Answer 20

FATIGUE!!!!!

1. sensory symptoms in arms/legs
2. unilateral vision loss
3. slowly progressive motor deficit
4. dipolopia
5. polysymptomatic onset

Question 21

what are oligoclonal bands?

Answer 21

IgG of similar size

Question 22

oligolclonal bands also elevated in which other 2 disorders?

Answer 22

lyme disease, syphillis, lupus

Question 23

what is a visual evoked response? what is it in an MS pt?

Answer 23

meaures how log occipital cortex takes to detect retinal input

normally takes 100seconds.

in MS, optic nerve demyelinated therefore takes longer.

Question 24

what is an afferent pupillary defect consistent with in MS?

Answer 24

demeylination and axon damage on side of lesion

Question 25

what is described below: 1. clinical episode suggestive of an MS' pts first relapse 2. optic nerves --\> optic neuritis 3. brainstem = internuclear opthalmoplegia 4. spinal cord - PARTIAL transverse myelitis 5. lasts at least 24 hours 6. in pt that is 20-45 years old w/ no evidene of fever, infection, or encephalopathy

Answer 25

CLINICALLY ISOLATED SYNDROME

Question 26

MRI used to dx MS how?

Answer 26

MRI used to determine lesions that are disseminated in time or space

Question 27

the rule of 2's in MRI dx of MS

Answer 27

need to have lesions that show dissemination in time (gad and non-gad lesions) and SPACE (lesions in multiple areas)

Question 28

risk of getting MS if no MRI lesion at 14 yrs? riks of getting MS if 1+ lesion on MRI?

Answer 28

no MRI lesion - 20% MRI lesion = 90% risk

Question 29

which two MRIs should you order in work up for MS?

Answer 29

T1 w/GAD T2 or flair in the saggital view

Question 30

drugs used to tx MS-related symptoms? STeroids used for ACUTE relapses

Answer 30

STEROIDS used for acute relapses, BUT NEVER BEEN shown to later natrual history of disease -drugs like interferon-beta reduce risk of relapse, new plaque formation, and neuro progression

Question 31

t/f. never make a dx of MS by MRI alone

Answer 31

true

Question 32

MS = still a clinical dx - subacute onset: optic neuritis, INO, nystagmus, partial myelitis, and cerebellar syndromes. - focuse on pt's complaint: vision, nyastagmus, gait - ask about sexual dysfunction and incontinence.

Question 33

what does early urinary retention suggest?

Answer 33

spinal cord lesion

Question 34

what acutely enchances with gadalonium and is limited to 1-2 vertebral bodies?

Answer 34

TRANSVERSE MYELITIS

Question 35

what is an acute neurologic condition that reflects **_focal inflammation_** of the spinal cord that acutely or subactuly develops motor, sensory, and sphincter disturbance and is usually asymmetrical with a spinal segmental level of of sensory disturbance with WELL Defined upper limit?

Answer 35

transverse MYelitis

Question 36

is spine compressed in transverse myelitis?

Answer 36

no

Question 37

t/f. Transverse myelitis may be 1st sign of MS in 30% of pts?

Answer 37

true

Question 38

how do you tx transverse myelitis?

Answer 38

IV steroids

Question 39

what is described by: severe thoracic pain, bouts of optic neuritis, acute paraparesis w/urinary retention?

Answer 39

neuromyelitis optica

Question 40

how many vertebral levels involved in neuromyelitis optica?

Answer 40

AT LEAST 3 CONTIGUOUS!

Question 41

pathology of neuromyelitis optica?

Answer 41

eosiniophils, neutrophils, hyalinized BVs (distinguishes it from MS)

Question 42

what is the mechanism of destruction of nueromyelitis optica?

Answer 42

antibody mediated demyelination, axonal injury and necrosis

Question 43

definite NMO characterized by which two diseases?

Answer 43

optic neuritis and acute myelitis acute contigious spinal cord MRI lesin extending over \>3 vertebral segments

Question 44

NMO pearls: 1. AB mediated disease of CNS 2. SEvere, relapsing 3. MRI spine: T2 weighed lesions that extend contigously over 3 consecutive vertebral bodies (find acute scan) 4. brain MRI: normal or minimal changes in MRI -lesions "atypical for MS) 5. NMO-IgG to **_AQUAPORIN-4_** 5. CSF: elevated WBC(\>50), NEUTROPHILS OR EOSINOPHILS, NEGATIVE FOR OLIGOCLONALBANDS, SCREEN ANY PT W/RECURRENT OPTIC NEURITIS OR MYELITIS HICCUP IN PT W/MYELOPATHY TX: IMMUNOSUPPRESSIVE (STEROIDS)

Question 45

what is described: thoracic pain/urinary problems(myelitis) + repeat optic neuritis+ acute parapareis + AB to aquaporin 4?

Answer 45

nueromyelitis optica