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Neuro Merchut > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

immune mediated destruction of CNS w/ secondary loss of axons

A

MS

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2
Q

classic MS lesion

A

demarcated white matter plaques, have a periventricular prominence

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3
Q

initial step in pathogenesis

A

lymphocytes and macs penetrate BBB

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4
Q

MS vs other leukodystrophies (demyelinating dzs)

A

MS gives autoimmune destruction of myelin

leukodystrophies have abnl myelin produced (defective synthesis)

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5
Q

MS affects people from what location

A

born and raised in temperate latitudes or global zones father from the equator (maybe related to lower vit D levels?)

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6
Q

“risk factors” for MS

A

genetically susceptible
exposure to triggering factors (maybe virus)
live in temperate zones

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7
Q

amount of inc risk for siblings of MS patient

A

20-fold inc risk

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8
Q

MS population

A

young adults 20-40 y/o

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9
Q

F:M ratio for MS

A

2:1

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10
Q

first course of MS

A

80% relapsing-remitting

20% primary progressive

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11
Q

2nd phase for MS pts who started relapsing-remitting

A

secondary progressive phase - less recovery

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12
Q

primary progressive MS pathogenesis

A

different from relapsing-remitting type, doesn’t respond well to immunomodulators

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13
Q

cause of death for MS

A

infection, malnutrition, and pulm emboli –> complications of immobility

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14
Q

initial sxs of MS

A

optic neuritis, sensory/motor deficits in lower limbs, internuclear opthalmoplegia

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15
Q

MLF lesion

A

aka internuc opthalmoplegia - blurry vision/diplopia

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16
Q

Lhermitte’s sign is due to

A

due to short circuiting w/in posterior columns of C spine from MS plaques, Vit B12 deficiency, or compression of spinal cord

17
Q

electric shock/tingling down spine into arms/legs provoked by neck flexion

A

Lhermitte’s sign

18
Q

MS “attack”

A

aka relapse/exacerbation
lasts 24+ hrs
no fever/infection

19
Q

MS pseudo-exacerbation

A

looks like recurrence but is due to infection (inc temp causes impaired depol/conduction thru a remyelinated region)

20
Q

historic dx for MS

A

sxs disseminated in time and space w/ no other identifiable cause

21
Q

current dx for MS

A

use MRI (high sensitivity, but not specific, for white matter lesions)

22
Q

monophasic mimics of MS (aren’t “disseminated in time”)

A

post-infectious encephalomyelitis

23
Q

aging of lesions via MRI

A

acute/new lesions enhance (inflamm), chronic/inactive lesions don’t enhance

24
Q

CSF for MS

A

oligoclonal bands

inc Ig synthesis

25
Q

MS evoked potentials

A

delayed cortical response to stimuli

26
Q

MS tx for acute aggressive attack

A

IV high dose steroids (methylpred 500-1000 mg/day x 3-5 days +/- prednisone taper)

27
Q

method to”help prevent “MS flare” sxs

A

fever control

28
Q

tx to reduce severity/frequency of MS attacks

A

DMT - beta IFN or glatiramer acetate

29
Q

protein that inc suppressor T cell fxn, dec lymphocytes entering CNS, dec antigen presentation, dec cytokine production

A

beta IFN

30
Q

Betaseron

A

IFN beta-1b

subq injection every other day

31
Q

Avonex

A

IFN beta-1a given IM weekly

32
Q

Rebif

A

IFN beta-1a given subq 3x/wk

33
Q

Glatiramer acetate (aka Copaxone)

A

polypeptide resembling myelin basic protein (byproduct of myelin destruction) , given subq daily

34
Q

MS tx to dec limb spasticity

A

Dilfampridine (4-aminopyridine)

35
Q

Dilfampridine (4-aminopyridine)

A

K channel blocker

inc walking speed

36
Q

Natalizumab (Tysabri)

A

interferes w/ binding of lymphocytes to CNS vasc cell adhesion machines

37
Q

complication of Natalizumab

A

reactivation of JC virus

38
Q

other oral meds for MS

A

fingolimod (Gilenya), teriflunomide (Aubagio) and dimethyl fumarate (Tecfidera)

Neuro Merchut (18 decks)

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