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Flashcards in MS Deck (20):
1

eye pathology

optic nerve infiltration
-dilation with light

2

positive MS findings

W>M
weakness and paresthesias

increased protein levels and oligoclonal bands on electrophoresis

Multiple T2 hyperintense areas consistent with demyelination are seen on MRI

3

initiating cause MS

UK, auto-immune medicated inflammatory demyelination and axonal injury

4

MS pathophys

1) Breakdown of the blood-brain barrier
2) Periventricular mononuclear infiltrates
3) Circumscribed areas of myelin breakdown

5

injury to CNS neuronal axons which may account for ??

brain atrophy and permanent damage seen in advanced disease

6

ddx

vasculitis
paraneoplastic smCC
neurosarcoidosis
SLE, ALS, CNS disorders
Behcet disease
lymphoma
HIV
Lyme disease

7

MS symptoms

Unilateral visual
impairment*
Double vision*
Paresthesias*
Ataxia or unsteadiness*
Vertigo
Fatigue
Muscle weakness
Urinary disturbance
Dysarthria
Mental disturbance
*see chart

8

MS signs

Optic neuritis
Internuclear opthamoplegia (INO)
Nystagmus
Spasticity or hyperreflexia
Babinski sign
Absent abdominal reflexes
Dysmetria or intention tremor (vs. resting tremor in Parkinson's)
Impairment of central sensory pathways
Labile or changed mood

9

INO

slowing of adduction w.out ocular limitation
*see slide

10

what imaging??

MRI >>> CT!
shows abn. in >85%

lesions: multifocal, hyper intense on intermediate and T2-weighted MRIs (enhanced with Gadolinium)

not just in brain: the periventricular white matter, corpus callosum, cerebellum, cerebellar peduncles, brainstem, and spinal cord

plaques that take over

11

LP??

see what in CSF

can be helpful in MS

CSF: Oligiconal bands, increased IgG synthesis, and moderate lymphocytic bands, increased IgG synthesis, and moderate lymphocytic pleocytosis (

12

myolograms

not as helpful as in Guillain Barre

13

MS types
know 1st 3

Relapsing-remitting MS (RRMS)-research, good px

Secondary progressive MS (SPMS)

Primary progressive MS (PPMS)*worse! never stops even w. aggressive tx

Progressive-relapsing MS (PRMS)

14

acute exacerbations tx



if that doesn't work??

3-5 course high dose IV methylprednisilone (1 g/day)

sev. or steroid unresponsive: plasma exchange

15

tx to decrease relapse rate and intensity

Interferon beta-1b
Interferon beta-1a
Glatiramer acetate

16

very resistant disease tx

Natalizumab
Mitoxantrone

17

drugs for specific symptoms

Carbamazepine-trigeminal neuralgia, flexor spasms

Baclofen,Tizanidine-spasticity

Amantadine-fatigue
Modadinil-fatigue

18

**favorable predictors:

age

19

**unfavorable predictors

age >40, male sex, cerebellar or pyramidal tract findings at initial presentation, frequent attacks in first 2 years, incomplete remissions, chronically progressive, many lesions on MRI

20

MS caused by

damage to myelin and axons