Quiz 8 - MS, demyelination Flashcards Preview

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Flashcards in Quiz 8 - MS, demyelination Deck (24):
1

gender ratio of MS

2/3 are female

2

MS predisposition

HLA DR2

3

types of MS

1) relapsing-remitting
2) secondarily progressive - more aggressive, faster decline, less remission
3) primary progressive - no episodes, no sudden onset, diagnosed during illness with MRI
4) progressive relapsing - mix of decline with occasional episodes

4

what is an exacerbation/attack?

- neurologic disturbance
- lasts longer than 24 hours
- at least 30 days between attacks (shorter is just the same attack waxing and waning)

5

pathophysiology of MS attack

- Th cells activated for unknown reason
- attracted to vessels of BBB
- breakdown of BBB
- Th cells reencounter antigens in CNS
- attack CNS myelin

6

sensory symptoms of MS

- numbness/paresthesias
- can be poorly localized
- unilateral or bilateral

7

vision in MS

- optic neuritis very common
- double vision

8

motor problems in MS

- ataxia
- dysmetria
- hemiparesis possible
- bladder/bowel
- sexual dysfunction

9

MS symptoms increased by

overheating

10

easiest and hardest types of MS to diagnose

easiest - relapsing-remitting (most common)
hardest - primary progressive

11

classical definition of MS

multiple white matter lesions separated in space and time

12

is there a biological test for MS?

no

13

definitions of space and time

time - at least 30 days between clear symptoms
space - at least two anatomic events confirmed by imagery

14

diagnostic criteria for MS

- objective abnormalities of CNS
- white matter involvement predominant
- at least two lesions
- 2 or more events over 6 months
- no other disease explains it

15

diagnostic categories of MS

- at risk - all criteria are met except
has only been one episode and one finding on exam
no clinically isolated syndrome
- probably MS - all criteria are met except
missing one event or one exam finding
- clinically defined - all criteria are met

16

MRI criteria for the two lesions in space and time

space - two or more lesions in at least two of the following
- periventricular
- juxtacortical
- spinal cord
- infratentorial
time - change in lesions from one MRI to the next, or lesions at different stages in same MRI

17

utility of different MRI studies

T1 - look for black holes and atrophy
T2/FLAIR - disease burden via BPF
T1 + gadolinium - recent events

18

what is the BPF?

brain parenchymal fraction
- fraction of brain taken up by lesions

19

how does a FLAIR image work?

- de-emphasizes free water
- shows parenchymal lesions very well

20

Dawson's fingers

radiation of plaques away from ventricles, best seen in sagittal FLAIR image

21

CSF positive for MS....

more than three oligoclonal IgG bands present

22

VER findings in MS

- either a delay or a weakened response to visual stimulus as seen on EEG

23

treatment of acute MS attack

IV steroids

24

MS treatments, indications, and cautions

B-interferon - RRMS and CIS, has significant side effects

glatiramer acetate - RRMS, decoy for Th cells, less side effects than B-interferon but you have to take it every day

mitoxantrone - used in secondary progressive, toxic, cardiomyopathy possible

natalizumab - can cause leukoencephalopathy in JC virus

fingolimod - oral