Bb1 Ms And Guillain Barre

Front 1

MS: general definition?

Back 1

Chronic and progressive inflammatory CNS disorder in which focal lymphocytic infiltration leads to the destruction of oligodendrocytes and the demyelination of axons

Front 2

MS: general progression?

Back 2

Initially, the inflammation is transient and some remyelination occurs, but over time microglial and astrocytic activation is thought to result in a chronic inflammatory response which results in widespread pathology.

Front 3

MS: general cause?

Back 3

Autoimmuneish - The activated T cell mediated response is believed to be triggered by a variety of agents. Autoreactive lymphocytes cross the BBB and attack myeline basic or other proteins expressed by oligodendrocytes and possibly neurons.

Front 4

Plaques of MS: location?

Back 4

Any CNS tissue can be affected (therefore any pathways can be affected)
Proclivity for the deep white matter of the hemispheres surrounding the lateral ventricles

Front 5

General MS presentation/timeline

Back 5

Alternating periods of exacerbations (characterized by active plaques where there is microglial and astrocytic activation and inflammation) and remissions (when inflammation decreases)

Front 6

What is responsible for any remyelination occurring in MS? Describe the process.

Back 6

OPCs in the surrounding areas that differentiate into mature myelin-producing oligodendrocytes. Remyelination is sparse and myelin sheaths are thin. Believed to contribute to periods of remission early in the course of the disorder.

Front 7

How do plaques change over time and what does this result in?

Back 7

Active plaques evolve into 'old' plaques where astrocytes lay down scars. Appears to be deleterious to the recruitment of OPCs from surrounding tissue, so no remyelination occurs.

Front 8

Common signs/symptoms of MS

Back 8

Paresthesias
Ocular symptoms: blurry vision, eye pain, blind spots
Motor (weakness) and cerebellar (ataxia) signs/symptoms
Lhermitte's sign

Front 9

What is the most common cause of ocular symptoms in MS?

Back 9

Optic neuritis (inflammation associated with demyelination of the optic nerve)

Front 10

What is Lhermitte's sign in MS?

Back 10

If the dorsal columns of the spinal cord are involved, flexion of the neck (which cases stretching of the dorsal columns) can elicit a painful, electric-like sensation down the spine.

Front 11

How is a clinical diagnosis of MS made?

Back 11

If the individual has attacks at two or more different times and shows evidence of at least 2 separate lesions in the CNS (separated in time sand space)

Front 12

Lab testing in MS

Back 12

Oligoclonal bands (bands of IgG on electrophoresis of CSF indicating production of autoantibodies within the CNS)

Front 13

Plaque imaging

Back 13

MRI
MRI with gadolinium will show focal enhancement of active plaques

Front 14

Four courses of MS

Back 14

Benign
Relapsing remitting
Secondary progressive
Primary progressive

Front 15

Describe benign MS.

Back 15

Mild infrequent exacerbations with full recovery

Front 16

Describe relapsing remitting MS.

Back 16

Episodes of exacerbations and remissions during which not all symptoms resolve completely. Relapses are often more severe than in the benign group, and can become more severe with time.

Front 17

Describe secondary progressive MS.

Back 17

Relapsing/remitting disease begins to gradually worsen over time with resulting accumulation of neurological signs and symptoms. Relapses become more severe while remissions are less complete, shorter in duration, and eventually non-existent.

Front 18

Describe primary progressive MS.

Back 18

No periods of remission. Disease begins with a slow progression of neurological deficits; problems gradually worsen over time.

Front 19

List general therapy of MS

Back 19

Immunomodulatory agents
Avoidance of possible triggers (heat, infections, etc.)
Treatment of spasticity/rigidity
Treatment of depression (tricyclics, SSRIs)
Treat for fatigue
Treatment for chronic neuropathic pain state

Front 20

What is the purpose of immunomodulatory agents with MS?

Back 20

Don't affect the ultimate progression of the disease, but decrease the number of flare-ups.

Front 21

What is Uhthoff's sign?

Back 21

Worsening of symptoms in MS patients which occurs after taking a hot bath or participating in vigorous exercise.

Front 22

What are potential causes for the chronic neuropathic pain state in MS?

Back 22

Chronic inflammation of axons or destruction of neurons of the pain pathway

Front 23

GB: cells affected? general progression?

Back 23

Schwann cells in the PNS (axons are spared)
Rapid in onset, remyelination occurs over time

Front 24

GB: cause?

Back 24

Immune-related demyelination following viral illness, enteritis, or other infections

Front 25

GB: most common symptoms?

Back 25

Paresthesias and weakness
Areflexia
Respiratory failure and autonomic dysfunction

Front 26

Contrast the weakness in MS and GB.

Back 26

Weakness in GB is an ascending weakness and may be bilateral

Front 27

What causes respiratory failure in GB?

Back 27

Demyelination of the phrenic and intercostal nerves

Front 28

What causes autonomic dysfunction in GB? What does this result in?

Back 28

Demyelination of the sympathetic and vagus nerves

Can lead to cardiac arrhythmias, tachycardia, postural hypotension, and HTN

Front 29

CSF of GB

Back 29

Elevated protein
Normal or only slightly elevated number of cells

Front 30

Treatment of GB

Back 30

Hospitalization until weakness subsides
Monitor respiratory function, intubation may be necessary