Lecture 4-MS/MG Flashcards

1
Q

a slowly progressive demyelinating disorder og the CNS

A

MS

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2
Q

patho of MS

A
  • attack of myelin sheath

- CNS WHITE MATTER LESIONS SEPARATED BY TIME AND SPACE

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3
Q

area primarily affected in MS

A

white matter of cervical and dorsal region of lateral and posterior columns
-also optic nerves and periventricular areas

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4
Q

characteristics of MS

A

visual changes

  • dizziness
  • numbness
  • incoordination
  • dysdiadochokinesia (difficulty with RAMs)
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5
Q

avg age of onset of MS

A

30

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6
Q

most common neurologic disability beginning in early to middle adulthood

A

MS

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7
Q

most frequent presentations of MS

A
  • fatigue
  • paresthesias of extrem.
  • clumsiness or weakness
  • visual disturbances
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8
Q

signs of MS

A

internuclear ophthalmoplegia, lhermitte’s sx, optic neuritis, pyramidal tract involvement results (hyperreflexia, clonus), cerebellar involvement, posterior column involvement (reduced vibration and proprioception)

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9
Q

what is internuclear ophthalmoplegia

A

lesion in mlf

-paresis of medial rectus muscle on lateral conjugate gaze, but not on convergence

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10
Q

what is lhermitte’s sx

A

neck flexion sends sensation of elevtrical shock down back to legs

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11
Q

what is optic neuritis

A

decreased visual acuity, defective pupillary reaction to light

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12
Q

what is marcus gunn pupil

A

afferent pupillary defect

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13
Q

relapsing-remitting MS

A
  • most common

- attacks of sxs that come on over 1-2 weeks and resolve in 4-8 weeks

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14
Q

secondary progressive MS

A

relapsing-remitting at first, then evolves to relapsing progressive

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15
Q

primary progressive MS

A

gradual preogression

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16
Q

most common form of MS in pts who develop ds after age 40

A

primary progressive MS

17
Q

lab studies for MS

A
  • CSF analysis

- MRI

18
Q

csf findings for MS

A

elevated total IgG

-presence of oligoclonal bands

19
Q

best radiographic test and most sensitive overall test for MS

20
Q

MRI findings of MS

A

periventricular plaques (bright signals)

21
Q

tx of MS

A
  • acute attacks-high dose steroids
  • ongoing disease-interferon beta-1a and beta-1b; glatiramer (synthetic analog of myelin basic protein
  • +/- immunosuppressants
22
Q

sx management of MS

A
  • spasticity: baclofen, tizanidine, clonazepam
  • ataxia: no effective tx
  • temperature sensitivity: cool pools and cooling suit
  • contractures: surgical release
  • incontinence: anticholinergics
  • sexual dysfunction: sildenafil
  • pain: TCAs, baclofen, clonazepam, gapapentin
  • fatigue: amantadine, pemoline
  • depression: counseling, antidepressants
  • assist devices: canes, walkers, etc
23
Q

an autoimmune disorder og the NMJ

A

myasthenia gravis

24
Q

patho of MG

A

circulating antibodies attack and destroy AChRs

25
this is abnormal is 75% of cases of MG
thymus
26
additional defect a/w MG
postsynaptic folds are flattened
27
signs and sxs of MG
- muscle weakness/fatgiue that is worse with continued activity and improves with rest - eyelid weakness and EOM weakness - normal DTRs
28
dx tests of MG
- repetitive exercises to reproduce sxs - tensilon test (edrophonium): results in temporary improvement of muscle strength - acetylcholine receptor antibody test (+ test is diagnostic, - test does not r/o) - EMG: decremental response (aka fatigability) - CT or MRI to check for thymoma
29
lambert-eaton myasthenic syndrome
- presynaptic disorder - incremental responses on repetitive nerve stim - depressed or absent DTRs - small cell CA of lung most common malignancy a/w LE
30
tx of MG
- anticholinesterase drugs (pyridostigmine) - thymectomy - immunosuppresive drugs (prednisone, azathioprine, cyclosporine) - plasmapheresis - IV Ig