Quiz 8 - MS, demyelination

Question 1

gender ratio of MS

Answer 1

2/3 are female

Question 2

MS predisposition

Answer 2

HLA DR2

Question 3

types of MS

Answer 3

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

Question 4

what is an exacerbation/attack?

Answer 4

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

Question 5

pathophysiology of MS attack

Answer 5

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

Question 6

sensory symptoms of MS

Answer 6

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

Question 7

vision in MS

Answer 7

• optic neuritis very common

- double vision

Question 8

motor problems in MS

Answer 8

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

Question 9

MS symptoms increased by

Answer 9

overheating

Question 10

easiest and hardest types of MS to diagnose

Answer 10

easiest - relapsing-remitting (most common)

hardest - primary progressive

Question 11

classical definition of MS

Answer 11

multiple white matter lesions separated in space and time

Question 12

is there a biological test for MS?

Answer 12

no

Question 13

definitions of space and time

Answer 13

time - at least 30 days between clear symptoms

space - at least two anatomic events confirmed by imagery

Question 14

diagnostic criteria for MS

Answer 14

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

Question 15

diagnostic categories of MS

Answer 15

• 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

Question 16

MRI criteria for the two lesions in space and time

Answer 16

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

Question 17

utility of different MRI studies

Answer 17

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

Question 18

what is the BPF?

Answer 18

brain parenchymal fraction

- fraction of brain taken up by lesions

Question 19

how does a FLAIR image work?

Answer 19

• de-emphasizes free water

- shows parenchymal lesions very well

Question 20

Dawson’s fingers

Answer 20

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

Question 21

CSF positive for MS….

Answer 21

more than three oligoclonal IgG bands present

Question 22

VER findings in MS

Answer 22

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

Question 23

treatment of acute MS attack

Answer 23

IV steroids

Question 24

MS treatments, indications, and cautions

Answer 24

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