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Flashcards in MS/MG & ALS Deck (38)
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1

Define MS

1. inflammatory demyelinating disease of CNS: Brain, SC, and optic nerve
2. White and Grey matter

2

What gender is MS MC in? Age range?

Females
20-40 y.o.

3

MS etiology

1. Autoimmune: HLA alleles
2. Vitamin D deficiency
3. Identical twins association

4

Define optic neuritis

-Loss of vision in affected eye and pain with eye movement
-Phosphenes: Circular "stars"

5

Define acute transverse myelitis

Acute partial loss of:
1. Motor
2. Sensory
3. Autonomic
4. Reflex

6

Lhermittes Sign

"Barber shop" test
Neck flexion causes lightning-shock type pain radiation from spine down leg

7

What are the MC MS sx's?

1. Paresthesia, Trigeminal neuralgia
2. Optic neuritis
3. Acute Transverse myelitis
4. Fatigue
5. Autonomic SC sx: Bowel (constipation), bladder dysfunction
6. Heat intolerance
7. Ataxia

8

Uhthoff's phenomen

Worsening symptoms with heat intolerance

9

Neuro PEx findings in MS

1. Spasticity and Positive Babinski. (toes move up)
2. Ataxic gait

10

Eye PEx findings in MS

1. Interneuclear Ophthlmoplegia
2. Nystagmus

11

What is the imaging of choice to help confirm and monitor the disease progression of MS?

MRI of brain and SC WITH Gadolinum

12

LP findings in CSF suggestive of MS

1. Oligoclonal bodies
2. Immunoglobulin G (IgG)

13

MS diagnostic criteria

Dissemination in time and space

14

Management of acute MS exacerbations?

High dose corticosteroids (IV Methylprednisone)

15

First line treatment for RRMS to reduce frequency and severity of relapse?

B-Interferon or Glatiramer acetate

16

What helps with fatigue in MS?

Amantadine and Modafinil

17

Define Myasthenia Gravis

Rare autoimmune disorder=antibodies against Ach postsynaptic receptor @ neuromuscular junction= Decreased Ach receptors= Progressive SKELETAL MUSCLE weakness

18

Who is MG MC in? Age?

Young Females= 30's

19

MG Clinical Manifestations

Fluctuating, fatiguable muscle weakness
1. Ocular weakness: Diplopia and ptosis
2. Generalized muscle weakness: Bulbar and respiratory

20

What is NORMAL in MG that. helps differentiate it from other diseases?

1. Normal Sensory
2. Normal DTRs

21

MG PEx

1. Myasthenic snarl: Bilateral facial muscle weakness
2. Recovery after rest

22

What is the most reliable test for diagnosing MG?

anti-acetylcholine receptor antibody test

23

Why would you want to order a CT scan in MG?

Rule out Thymoma or thymus abnormality

24

What is first line treatment in MG?

Anti-cholinesterase inhibitors

25

List Anti-cholinesterase inhibitors

1. Pyridostigmine
2. Neostigmine

26

List immunosuppression therapy in MG and indication

1. IV Immune Globulin (IVIg): in myasthenia crisis for rapid response
2. Plasmapheresis
3. Prednisone: Short and Long term benefit

27

What is the major complication of myasthenia gravis

Myasthenia crisis= respiratory failure

28

Define ALS

Mixed UMN and LMN neurodegenerative disease: Progressive motor degeneration

29

What is another name for ALS?

Lou Gehrig's disease

30

UMN sx's

1. Spasticity in LE
2. Stiffness
3. Hyperreflexia

31

LMN sx's

1. Progressive bilateral fasciculations
2. Muscle atrophy
3. Muscle weakness
4. Hyporeflexia

32

What dysfunction do we not see in ALS?

No dysfunction of:
1. Cognitive/behavioral
2. Sensory
3. Autonomic

33

What movements are spared in ALS?

1. Urinary sphincter
2. Voluntary eye movements

34

What are common first sx's?

1. Drop foot
2. Walking
3. Speech
4. Dexterity

35

Bulbar sx's in ALS

1. Dysphagia
2. Dysarthria

36

Later stages in ALS

1. Swallowing-Aspiration pneumonia
2. Intercostal-Poor lung function

37

ALS treatment

Riluzole- Reduce progression by 2-3 months

38

Riluzole MOA

Inhibits presynaptic release of Glutamate