Lecture 64: Multiple Sclerosis Flashcards Preview

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Flashcards in Lecture 64: Multiple Sclerosis Deck (28):
1

Typical MS lesion sites/symptoms (4)

Monocular vision loss, brainstem syndromes (cranial nerve deficits), spinal cord = motor/sensory impairments, imbalance

2

Early features

Motor weakness, paresthesias, impaired vision, double vision, intention tremor, ataxia

3

T/F: Diagnosis of MS is certain initially

False! One lesion location is hard to diagnose

4

How do you recognize MS early?

MRI!

5

Original triad for MS presentation and where they localize. How do we feel about this now?

Intention tremor, nystagmus, scanning speech (WM pathways to and from cerebellum); we now try to treat LONG BEFORE its gotten this far

6

What is the most common place for MS lesion? Name of disease and presentation.

Optic nerve; neuritis; painful gradual (days) loss of vision in ONE eye often with scotoma of central vision

7

How often do you see optic edema? How many patients w/ optic neuritis get better completely? How many will end up with MS?

50%; 33%; 50%

8

Four CRITICAL clinical patterns of MS. Does a patient always have just one?

Relapsing remitting; secondary progressive; primary progressive; progressive relapsing; NO--secondary progressive FOLLOWS relapsing-remitting

9

Relapses get more/less frequent over time

Less frequent

10

Describe secondary progressive disease

Starts w/ relapses, but then continues to progress (more disability) over time w/ or w/out relapses

11

Do lesions always coordinate with symptomology?

Nope! Can have many new lesions w/out new symptoms

12

% patients who begin with RRMS, % who will go into secondary-progressive

85%; 50% (NATURAL HISTORY, NOT W/ TREATMENT)

13

Epidemiology of MS (age, gender, race, location)

20-40; 2-3 x women; N European; more w/ northern exposure

14

Genes of MS

Higher risk in first degree relatives

15

Criteria in MS (name) and principle

McDonald Critera; look for evidence of dissemination in space and time

16

When you give dye...what lights up?

Areas of the nervous system that are actively inflamed, light up

17

Classical MS lesions

Multiple, round, peri-ventricular WM

18

Relationship b/t MS and lesions

MRI lesions predict development of MS after first attack

19

What causes MS on a cellular level?

Inflammatory attack of oligodendrocytes by self-reactive T1 cells that cross compromised BB barrier

20

Misguided T cells mistake...

Myelin for an antigen

21

CSF in MS

Increased IgG synthesis rate and IgG oligoclonal bands (90% have them but we don't know what they target)

22

Under the microscope...

Inflammatory infiltrates in MS lesions

23

Treating exacerbation

High dose IV steroids

24

Goals of treatment (4)

Prevent relapse, prevent disability, clinical stability, decrease new lesions

25

Where do lesions always call symptoms?

Spinal cord, optic nerve (shallow end)

26

Where do lesions rarely cause symptoms?

Juxtacortical, periventricular (deep end)

27

Where do lesions sometimes cause symptoms?

Brainstem, cerebellum

28

What happens over time with MS?

The reserve is decreased (loss of neurons), eventually the many lesions come to light

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