Multiple Sclerosis

Question 1

What is the process of demyelination?

Answer 1

a disruption of myelin, which is the coating around neurons

Question 2

What produces myelin?

Answer 2

oligodendrocytes in the CNS

schwann cells in the PNS

Question 3

What causes multiple sclerosis?

Answer 3

a disease of the CNS caused by an autoimmune attack on oligodendrocytes resulting in multiple areas of demyelination.

Question 4

MS is one of the leading causes of what?

Answer 4

neurological disability in young adults

Question 5

what are the risk factors of MS?

Answer 5

age, gender, genetics and environment

Question 6

95% of those diagnosed with MS are in what age range?

Answer 6

15-55

Question 7

What is the gender preference for MS?

Answer 7

females

Question 8

What is the chance you will get MS if both of your patents have MS?

Answer 8

9%

Question 9

What is the gene associated with the genetic component of MS?

Answer 9

HLA-DR2

Question 10

What is an interesting caveat about where you live in regards to likelihood of MS?

Answer 10

individuals in the northern states have a 3x higher likelihood of developing MS then people in southern states. If someone moves before the age of 15, they will not carry the risk with them.

Question 11

What are possible mechanisms of MS?

Answer 11

molecular mimicry and failure of colonal deletion

Question 12

What is a hallmark of MS?

Answer 12

multiple scarred foci (plaques) with in the white matter of the CNS and perivenular inflammation

Question 13

What happens when the myelin is disrupted?

Answer 13

decrease in saltatory conduction and action potentials are unable to be effectively transmitted down axons, leading to neurological dysfunction

Question 14

What are the types of MS?

Answer 14

relapsing-remitting
primary progressive
secondary progressive
progressive relapsing

Question 15

What is a clinically isolated syndrome?

Answer 15

1st episode of transient neurological dysfunction

Question 16

What is relapsing remitting MS?

Answer 16

multiple episodes of transient neurological dysfunction which may or may not completely resolve. There is no progression between relapses.

Question 17

What is primary progressive MS?

Answer 17

No defined relapse or remission. Disease progresses relentlessly from its onset

Question 18

What is secondary progressive MS?

Answer 18

Patients with relapsing remitting MS may (after ~17 years) start to have some progression during relapses.

Question 19

What is progressive relapsing MS?

Answer 19

relentless progression from the onset but may have a rare relapse

Question 20

What do we need to diagnose MS?

Answer 20

dissemination in time and space

can be fulfilled clinically or radiographically

Question 21

What are the common presenting signs and symptoms of MS?

Answer 21

limb sensory loss - 31%
visual loss - 16%
sub acute weakness
diploplia
gait disturbance
vertigo
acute weakness

Question 22

What are two common clinically isolated syndromes associated with MS?

Answer 22

optic neuritis and transverse myelitis

Question 23

Is there a correlation between treatment and clinically isolated syndromes?

Answer 23

treatment after clinically isolated syndromes is showing to result in better outcomes and less disability over time

Question 24

What is optic neuritis?

Answer 24

demyelination of the optic nerve

characterized by the triad of :
visual acuity loss
dyschromatopsia
epsilateral eye pain especially with movement

Question 25

What does the neuro exam show for optic neuritis?

Answer 25

relative afferent pupillary defect

Question 26

What does an MRI show for optic neuritis?

Answer 26

increased T2 signal of the optic nerve

Question 27

What is the prognosis for optic neuritis?

Answer 27

good, complete or near complete recovery is expected

Question 28

What is transverse myelitis?

Answer 28

demyelination of the spinal cord; any of the ascending or descending tracts may be affected

Question 29

What are the typical symptoms of transverse myelitis?

Answer 29

sensory loss in one or both lower extremities often accompanied by a sense of heaviness.

Question 30

What does the neuro exam show for transverse myelitis?

Answer 30

spasticity, at sensory level, up going goes, and weakness

Question 31

What is commonly associated with transeverse myelitis?

Answer 31

L'hermitte's Phenomenon- a lightning like pain that radiates down spine with head antero flexion

Question 32

In the physical exam what is seen with MS?

Answer 32

charcots triad: nystagmus, intention tremor, and scanning speech (staccato)

Question 33

What are the diagnostic tests for MS?

Answer 33

LP, MRI(T2 and FLAIR) and visual evoked potentials

Question 34

What is the only nerve myelinated by oligodendrocytes?

Answer 34

optic nerve

Question 35

What is seen on a lumbar puncture in a patient with MS?

Answer 35

oligoclonal bands; This represents increased synthesis within the CSF of antibodies present in 95% of MS patients

Question 36

What do visuallly evoked potentials show in a positive diagnosis of MS?

Answer 36

increased latency to visual stimuli

Question 37

How do MS lesions typically appear on imaging?

Answer 37

periventricular (dawsons fingers) and ovoid

Question 38

How do we treat acute exacerbations of MS?

Answer 38

IV methylprednisone- 3-5 days (does not affect the progression of the disease, just increases recovery time) *oral prednisone is a/w increased subsequent attacks

Question 39

What is the disease modifying treatment for MS?

Answer 39

inteferon beta 1a inteferon beta 1b copaxone- random peptide chain of the most common AA in myelin

Question 40

What is the prognosis of MS?

Answer 40

Good, 90% are independent 10 yrs after dx

Question 41

What are signs of a good prognosis?

Answer 41

female, relapsing-remitting, and optic neuritis at onset with infrequent exacerbations

Question 42

What is Guillian Barre Syndrome?

Answer 42

demyelination of PNS that is likely post infectious or post vaccination in nature present with a rapidly progressing symmetric, ascending limb paralysis

Question 43

What are the main characteristics of Guillian Barre?

Answer 43

3A's: acute onset, ascending paralysis, areflexia

Question 44

What can GBS lead to ultimatley?

Answer 44

Respiratory failure

Question 45

What are the post infectious causes of GBS associated with?

Answer 45

GI illnesses from C. jejuni

Question 46

What is the prognosis of GBS?

Answer 46

if caught early enough, full recover is expected

Question 47

What is the treatment for GBS?

Answer 47

IV IG or plasmaphoresis