Flashcards in Lecture 64: Multiple Sclerosis Deck (28):
Typical MS lesion sites/symptoms (4)
Monocular vision loss, brainstem syndromes (cranial nerve deficits), spinal cord = motor/sensory impairments, imbalance
Motor weakness, paresthesias, impaired vision, double vision, intention tremor, ataxia
T/F: Diagnosis of MS is certain initially
False! One lesion location is hard to diagnose
How do you recognize MS early?
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
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
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%
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
Relapses get more/less frequent over time
Describe secondary progressive disease
Starts w/ relapses, but then continues to progress (more disability) over time w/ or w/out relapses
Do lesions always coordinate with symptomology?
Nope! Can have many new lesions w/out new symptoms
% patients who begin with RRMS, % who will go into secondary-progressive
85%; 50% (NATURAL HISTORY, NOT W/ TREATMENT)
Epidemiology of MS (age, gender, race, location)
20-40; 2-3 x women; N European; more w/ northern exposure
Genes of MS
Higher risk in first degree relatives
Criteria in MS (name) and principle
McDonald Critera; look for evidence of dissemination in space and time
When you give dye...what lights up?
Areas of the nervous system that are actively inflamed, light up
Classical MS lesions
Multiple, round, peri-ventricular WM
Relationship b/t MS and lesions
MRI lesions predict development of MS after first attack
What causes MS on a cellular level?
Inflammatory attack of oligodendrocytes by self-reactive T1 cells that cross compromised BB barrier
Misguided T cells mistake...
Myelin for an antigen
CSF in MS
Increased IgG synthesis rate and IgG oligoclonal bands (90% have them but we don't know what they target)
Under the microscope...
Inflammatory infiltrates in MS lesions
High dose IV steroids
Goals of treatment (4)
Prevent relapse, prevent disability, clinical stability, decrease new lesions
Where do lesions always call symptoms?
Spinal cord, optic nerve (shallow end)
Where do lesions rarely cause symptoms?
Juxtacortical, periventricular (deep end)
Where do lesions sometimes cause symptoms?