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aNeuro Exam 2- Lindsey's > Inflammatory/ Demyelinating Diseases (MS) > Flashcards

Inflammatory/ Demyelinating Diseases (MS) Flashcards

1
Q

What behavioral changes are suggested for MS pts?

A
  • get good sleep
  • exercise
  • no smoking
  • take vitamin D
  • low salt diet
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2
Q

What do T1 with contrast-enhancing lesions in MS indicate?

A

BBB breakdown = bad short-term prognostic sign

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3
Q

What are the major features of Secondary Progressive MS (SPMS)?

A
  • about 50% of RRMS converts to this MS
  • changes from relapsing to only progressing
  • median age is 45yo
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4
Q

How is MS diagnosed?

A

McDonald Criteria:

  • multiple CNS lesions separated by space
  • 2+ symptoms lasting at least 24 hours, 30 days apart for RRMS or 12 mos apart for PPMS
  • abnormalities documented that can’t be explained otherwise
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5
Q

What causes MS?

A
  • both genetic and environmental factors
  • HLA DR2 = 3x risk
  • IL-7 and IL-2 receptor alpha chain mutations
  • viruses
  • vitamin D deficiency
  • smoking
  • obesity
  • high salt diet
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6
Q

What are the unfavorable prognostic signs in MS?

A
  • older age at onset
  • male
  • African American
  • high relapse rate
  • short interval to 2nd relapse
  • early cerebellar or motor involvement
  • early disability
  • high T2 lesion load on MRI
  • brain atrophy
  • smoker
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7
Q

What cells drive the pathogenesis of MS?

A
  • abnormal T lymphocytes
  • B lymphocytes
  • plasma cells
  • macs
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8
Q

How do MS lesions evolve over time?

A
  • at first = inflammatory
  • later = scar- like (sclerotic plaque)
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9
Q

How are acute MS attacks treated?

A
  • high dose corticosteroids
  • plasma exchange if unresponsive
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10
Q

Where in the CNS do MS lesions frequently occur?

A

in BOTH the brain and spinal cord

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11
Q

_____ is likely the most important prognostic MRI factor.

A

Atrophy

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12
Q

Dx?

  • early stage of MS
  • single relapse
  • diagnosed via MRI
  • not yet full MS but at high risk for developing it
A

Clinically Isolated Syndrome (CIS)

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13
Q

What CSF analysis findings indicate MS?

A
  • protein usually N1
  • WBC usually N1
  • glucose ALWAYS normal
  • increased and abnormal IgG
  • increased myelin basic protein
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14
Q

What are the major features of primary progressive MS (PPMS)?

A
  • about 15% of all MS pts
  • no relapses, just slow progression from onset
  • median age of onset = 45yo
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15
Q

What do T1 holes indicate in MS?

A

axonal damage = long term bad prognostic sign

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16
Q

What lab studies help diagnose MS?

A
  • MRI w/ and w/o contrast with FLAIR
  • CSF analysis
  • Evoked potentials (EPs)
  • optical coherence tomography (OCT)
  • blood tests
17
Q

What is Clinically Isolated Syndrome (CIS)?

A
  • early stage of MS
  • single relapse
  • diagnosed via MRI
  • not yet full MS but at high risk for developing it
18
Q

What are the neuro exam findings in MS?

A
  • asymmetric UMN/pyramidal tract signs (weakness, spasticity, Babinski sign)
  • decreased visual acuity
  • optic atrophy
  • afferent pupillary defect
  • eye movement abnormalities (nystagmus or INO)
  • sensory loss cerebellar signs (ataxia, tremor, dysarthria)
  • labile affect
  • cognitive dysfunction
19
Q

What is a meningeal nodule?

A

MS nodules containing B cell and plasma cells

20
Q

What is MS without relapses, only slow progression?

A

primary progressive MS (PPMS)

21
Q

Dx?

  • MRI scan with MS lesions but no symptoms in pt
  • large risk of evolving into MS
A

Radiologically Isolated Syndrome (RIS)

22
Q

What causes an acute MS relapse?

A
  • activation of peripheral T cells
  • antigen presentation and surface adhesion molecule display
  • activation of MMPs to produce BBB leakiness
  • T cells, B cells, macs, and complement enter CNS
  • cytokines released
  • myelin, oligodendrocytes, and axons are damaged
23
Q

What is the main goal of MS therapy?

A

life long brain health

24
Q

What are the late symptoms of MS?

A
  • early symptoms +:
  • fatigue
  • sexual dysfunction
  • depression
  • cognitive dysfunction
  • pain
  • dysphagia
  • sz’s
  • hearing loss
  • immobility
25
Q

What is Radiologically Isolated Syndrome (RIS)?

A
  • MRI scan with MS lesions but no symptoms in pt
  • large risk of evolving into MS
26
Q

Which viruses might contribute to MS development?

A
  • EBV
  • HHV-6
  • Chlamydia pneumoniae?
27
Q

The majority of young adults are diagnosed with which type of MS?

A

Relapsing-Remitting MS (RRMS)

28
Q

What are the early symptoms of MS?

A
  • parestheisas
  • monocular loss of vision
  • gait problems
  • weakness
  • diplopia
  • urinary dysfuncion
  • consipation
29
Q

What do T2 lesions indicate in MS?

A

pattern is specific to MS diagnosis

30
Q

What are the major features of Relapsing-Remitting MS (RRMS)?

A
  • sporatic episodes of new or worsened s/s (over 2-10 days)
  • variable improvement over 1-6 months
  • 85% of all pts with MS
31
Q

What kind of MS changes from relapsing to a progressive course?

A

Secondary Progressive MS (SPMS)

aNeuro Exam 2- Lindsey's (23 decks)

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