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CMT > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Multiple Sclerosis

define

A

most common immune mediated inflammatory demyelingating disease of the CNS

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2
Q

Multiple Sclerosis

epidemology

gender, age, genetics, environmental

A
  • female gender
  • age of onset: 28-31
  • genetic susceptibility
  • environmental
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3
Q

Multiple Sclerosis

characteristic feature on imaging

A
  • presence of focal demyelinated plaques in CNS (optic nerve, spinal cord, brainstem, cerebellum, juxtacortical/periventricular white matter)
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4
Q

Multiple Sclerosis

dx

2

A
  • clinical dx
  • get good PMHx, PE, MRI
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5
Q

Multiple Sclerosis

clinical manifestations

2

A
  • monosymptomatic: single lesion
  • polysymptomatic: > 1 lesion
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6
Q

Multiple Sclerosis

sensory sx

5

A
  1. numbness/tingling
  2. tightness (“MS hugs”)
  3. coldness
  4. swelling of lumbs/trunk
  5. intense pruritis (unilateral, cervical dermatomes)
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7
Q

Multiple Sclerosis

Neurologic Sx

5

A

cognitive impairment
* difficulty w/ attention
* short term memory
* speed of information processing
* abstract conceptualization

  • Frank Dementia
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8
Q

Multiple Sclerosis

sx of unilateral optic neuritis

A
  • painful monocular vision loss (visual blurring, partial vision loss)
  • 90% will recover their vision w/in 2-6 mo
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9
Q

Multiple Sclerosis

pain sx

4

A
  • paroxysmal (sudden) pain
  • persistent pain (burning, cold dyesthesias)
  • musculoskeletal
  • soft tissue
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10
Q

Multiple Sclerosis

descrive uhthoff phenomenon

3 components

A
  • heat sensitivity
  • small increases in body temp will worsen sx temporarily
  • due to conduction block in central pathways as temp increases
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11
Q

Multiple Sclerosis

GU Sx

5 components

A
  • urge incontinence
  • overactive bladder
  • functional bladder outlet obstruction
  • Urination: hesitancy, interrputed stream, incomplete emptying
  • Sexual: ED, decreased libido
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12
Q

Multiple Sclerosis

GI sx

4

A
  • urge incontinence
  • constipation
  • poor evacuation
  • incontinence
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13
Q

Multiple Sclerosis

Neurologic PE Findings

6 components

A
  1. Paraplegia/Paraparesis: lesions in the descending tract of the spinal cord
  2. Spasticity: tonic (resistance to movement) or phasic (involuntary jerks and spasms)
  3. lhermitte sign
  4. coordination problems (dysmetria, hypotonia)
  5. gait disturbances
  6. cerebellar dysarthria
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14
Q

Multiple Sclerosis

why might pts have diminished DTRs

A

lesions interrupting the reflex arc

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15
Q

Multiple Sclerosis

what is lhermitte sign

A

electric shock shooting down the spine or into the limbs (most often after flexion of the neck)

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16
Q

Multiple Sclerosis

sensory PE findings

A
  • vibtration/joint position sense impairment
  • patchy areas of reduced pain and light touch perception in limbs/trunk
  • Brown-Sequard Syndrome
17
Q

Multiple Sclerosis

describe Brown-Sequard Syndrome

2

A
  • testing sensation w/ sharp object, feeling is increased or spreads like ripple effect
  • contralateral weakness
18
Q

Multiple Sclerosis

Ocular PE Findings

4 components

A
  • optic neuritis (afferent pupillary defect w/ swinging flashlight test)
  • disc edema if head of optic nerve is involved
  • internuclear ophthalmoplegia
  • pendular nystagmus
19
Q

Multiple Sclerosis

what is seen on brain MRI

3 components

A
  • hyperintense white matter lesions
  • plaques (ring enhancing, ovoid)
  • black hole lesions (severe demyelination and axonal loss)
20
Q

Multiple Sclerosis

what would MRI spine show

5 components

A
  • if here, pt is less likely to be asx
  • size > 3mm but < 2mm
  • occupy only part of SC
  • little to no cord swelling
  • focal: clearly delineated, well-circumscribed
21
Q

Multiple Sclerosis

Spinal MRI describe chronic lesions

2

A
  • smaller
  • well-defined margins
22
Q

Multiple Sclerosis

Spinal MRI describe acute lesions

3 components

A
  • larger
  • ill defined
  • more gadolinium uptake (dissipates over a few wks)
23
Q

Multiple Sclerosis

when to do LP

A

if atypical clinical features, imaging features, or in an atypical population (kids or adults)

24
Q

Multiple Sclerosis

describe evoked potentials

A
  • electrical events generated in the CNS by peipheral stimulation of a sensory organ
  • detects subclinical abnormal CNS function
  • define anatomic site of lesion not easily visualized by imaging
25
Q

Multiple Sclerosis

describe optical coherence tomography

3

A
  • uses infrared light waves that reflect off the internal microstructure of biologic tissue to produce images
  • non-invasive way to image the retina
  • measure thickness of retinal nerve fiber layers
26
Q

Multiple Sclerosis

describe relapsing remitting MS

3

A
  • 80-95% of pts
  • attacks w/ full or incomplete recovery
  • minimal disease progression between relapses
27
Q

Multiple Sclerosis

describe Secondary Progressive MS

A
  • initial relapsing-remitting course followed by gradual worsening w/ or w/out occasional relapses, minor remissions, and plateaus
  • retrospective dx, no clinical criteria
28
Q

Multiple Sclerosis

describe Primary Progressive MS

A
  • progressive accumulation of disability from onset w/ occasional plateaus, temporary minor improvements or acute relapses
  • typical presentation: spinal cord syndrome worsening over months to years
  • clinical dx, only 10% of cases
29
Q

Multiple Sclerosis

describe clinically isolated syndrome

A

first clinical episode
* resembles typical MS relapse
* no known hx, doesn’t meet dx criteria

30
Q

Multiple Sclerosis

describe radiologically isolated syndrome

A
  • MRI findings suggestive of MS
  • no signs/sx
  • no hx of MS
  • risk factors: male, age > 37, spinal cord lesions
31
Q

Multiple Sclerosis

different tx strategies

A
  • tx of acute exacerbations w/ corticosteroids
  • reduction of biologic activity w/ DMARDs
  • sx management
  • rehab and psychosocial support
32
Q

Multiple Sclerosis

criteria for an acute attack

A
  • episode of focal neurologic disturbance > 24 hrs
  • preceding clinical stability for > 30d
  • consider MRI brain
33
Q

Multiple Sclerosis

acute attack tx

A
  • goal: lessen recovery time
  • glucocorticoids (methylprednisone IV or prednisone PO)
  • corticotropin injection gel
  • plasma exchange
34
Q

Multiple Sclerosis

IV Monocloncal Antibody tx

3

A
  • Natalizumab
  • Ocrelizumab
  • Alemtuzumab
35
Q

Multiple Sclerosis

which med has side effect of progressive multifocal leukoencephalopathy

A

natalizumab

36
Q

Multiple Sclerosis

Oral therapies: S1P Receptor Modulators

4

A
  • Fingolimod
  • Siponimid
  • Ozanimid
  • Ponesimod
37
Q

Multiple Sclerosis

Injectable Tx

A
  • Ofatumumab
  • Interferons
38
Q

Multiple Sclerosis

monitoring fot tx

A
  • routine visits every 3 mo
  • laboratory evaluation
  • imaging (MRI) repeat- baseline, 6 mo post tx, then annually

CMT (72 decks)

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