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34 Cards in this Set
- Front
- Back
What is Multiple Sclerosis (MS)?
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Chronic primary demylinating disease of the CNS; also causes axonal injury
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Is there one isolated trigger that causes MS?
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No
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What "causes" MS?
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Multifactorial - Genetic predisposition, autimmunity, infections
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What are the 2 primary viruses thought to cause MS?
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EBV and HHV-6
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Geographically, where is MS more common?
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In temperate climates such as northern europe and US/Canada
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When is the age of onset for MS?
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Highest between 25-35
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Is MS more prevalent in men or women?
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Women (2:1)
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What genetic risk factor has the highest assoiciation with MS?
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HLA-DRB1501 (MHC II)
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What is the overal risk for MS in the US?
For first degree relatives/fraternal twins? Identical Twins? |
US: 0.1%
1st degree / fraternal: 4% Identical twins: 30% |
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What is the most common progression/presentation of MS?
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With RRMS (relapsing-remitting MS) signs and symptoms
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How do the remainder of MS patients present?
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Primary progressive MS
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What are 5 typical MS symptoms?
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1. Focal Weakness (UMN signs)
2. Focal numbness / paresthesias 3. Coordination problems / tremors 4. Speech problems 5. Spastic Bladder |
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What is the first step in the pathogenesis of MS?
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Early demyelination that progress through an acute/subacute inflammatory phase with axonal injury, cellular infiltration (T cells/macrophages), and later glial scarring.
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Do MS lesions respect vascular boundaries/distributions?
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NO
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Are MS lesions well demarcated?
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YES
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A CEL (contrast enhancing lesion) that shows up on Gadolinium enhancing MRI indicates what?
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Acute inflammation (lesion)
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Dark spots in a T1 (black holes) represent what?
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Chronic lesions, permanent scar
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What are the major steps in the pathogenesis of MS?
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1. Immune activation of T/B cells (via poorly defined mechanisms) in PERIPHERY
2. B/T cells enter CNS 3. B/T cells activate resident CNS cells which attack self via MOLECULAR MIMICRY |
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What are the main distinct lesion patterns in "acute" MS?
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Type 1/2: Perivenular myelin loss W/ preservation of oligodendrocytes. 2 has IgG/complement deposition
Type 3/4: Myelin loss NOT perivenular w/ NO preservation of oligodendrocytes Both have macrophage and T cell infiltration |
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Within a single patient, are all lesions the same?
Between patients? |
ALL SAME w/ in single patient
Different between different patients |
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MRI findings of "Dawson's Fingers" indicates what type of lesion?
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Perivenular demyelination (Type I/II lesion)
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What is the main immune cell in the inflammatory mechanism of MS?
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T cells
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What is thought to be the underlying neuropathological cause for progressive disability in MS patients?
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Axonal transection/neuronal loss
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Classical symptoms of MS are referable to what?
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Dysfunction of White matter tracts
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With regard to vision, what is often seen in MS?
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Internuclear Opthalmoparesis (Patients can't move eyes together)
Caused by dysfunction of MLF |
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FLAIR/hyperintense MS lesion suggest what?
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Periventricular lesion (Dawson's Fingers)
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What can be seen wrt MS on a T2 MRI?
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Subacute and chronic plaques
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What can be seen wrt MS on a T1 MRI?
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Black holes - chronic lesions
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What can be seen on a gadolinium contrast MRI?
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Acute plaques
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Does MS characteristically have long or short cord lesions when detected by MRI?
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Short - <2 vertebral body segments
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Black holes on T1 indicate what?
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glial scarring in an area of axonal loss
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What type of lesion is strongly associated with MS disability?
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Black holes
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Apart from MRIs, what other tests can be used to detect demylinating lesions?
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Evoked potential - test for nerve conduction velocities in the CNS
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What, while not specific for MS, is found in 80-90% of patients with MS?
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Oligoclonal IgG bands - represent CNS immune response
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