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19 Cards in this Set

  • Front
  • Back
Myelin
High fat content, allows for faster more efficient conduction of electrical impulses; formed by oligodendrocyte in the CNS (Schwann cell in PNS); Loss of myelin leads to slowing of conduction and may progress to damage of the underlying nerve
Acute Transverse Myelitis
(1) Spinal cord dysfunction; (2) back pain, ascending sensory level, sphincter disturbance, paraparesis; (3) Many viral etiologies proposed; (4) May be the first episode of MS, especially is brain MRI is abnormal. ATM lesions tend to extend over 3 or more vertebral segments, more extensive than lesions of MS
Optic Neuritis
Acute or subacute onset of monocular visual blurring or loss, central blind spot; 90% of patients have PAIN with eye movement, loss of color vision, poor acuity, and an APD
Neuromyelitis Optica (Devic’s Disease)
Transverse myelitis and optic neuritis (often bilateral); Spinal cord MRI with longitudinally extensive lesion >2 vertebral levels; CSF shows PMN pleocytosis; Pathology differs from MS - there is an anti-NMO IgG antibody!
Acute Disseminated Encephalomyelitis (ADEM)
Acute demyelinating illness which commonly follows an infection or vaccination - more common in children; MRI shows bilateral symmetric inflammatory changes of the same age; ADEM is usally monophasic, but may be recurrent
Multiple Sclerosis
Idiopathic inflammatory demyelinating disease of CNS; Episodes of neurologic dysfunction "disseminated in time and space"; MCC of non-traumatic neurologic disability in young adults
Unfavorable Prognostic Factors in MS
(1) High MRI lesion burden at first episode; (2) Moderate-to-severe disability at 5 years; (3) Progressive clinical course from onset; (4) Male gender; (5) Late onset (age > 40 years); (6) Two or more relapses in first year
Initial symptoms in MS
(1) Sensory in limbs - 31%; (2) Visual loss - 16%; (3) Motor loss/slowing - 9%
Motor Symptoms in MS
(1) Corticospinal and corticobulbar tract lesions - UMN spastic weakness, spastic paraparesis is most common; (2) Cerebellar pathways - ataxia, tremor, incoordination, scanning speech usually occur later in course
Sensory symptoms in MS
(1) Occur in 75% of patients during course of disease; (2) Spinothalamic tract lesions common, resulting in dysesthesias, pain; (3) Dorsal column involvement less common
Lhermitte's phenomenon
Electric sensation passing down back and limbs upon flexion of neck
Internuclear ophthalmoplegia
Due to lesion in medial longitudinal fasciculus (MLF). Inability to adduct ipsilateral eye, with nystagmus on abduction of contralateral eye.
Cognitive changes in MS
Cognitive compromise in up to 60% of MS patients on detailed testing. “Subcortical” dementia: information processing, visuospatial, memory, executive dysfunction.
Increased immunoglobulin production/Oligoclonal bands in MS
Presence of 2 or more antibody clones. Indicates damaged blood-brain barrier or immunoglobulin production in the brain.
MS drugs
Avonex, Betaseron, Copaxone, Rebif (CRAB drugs) - only available by injection
Interferon Adverse Events
(1) Injection site reactions; (2) Flu-like complex in 60-70%; (3) Depression in 2%; (4) Elevated LFTs
CRAB Drugs: The Bottom Line
(1) Comparative trials are small, poorly controlled; (2) Differential trial designs make comparison from one agent to another difficult; (3) Each agent has its place in treatment in relapsing-remitting MS (RRMS); (4) Must be individualized to each patient
Other drugs for MS
(1) Tysabri - risk of PML! (2) Mitoxantrone - risk of cardiac toxicity, leukemia
Symptomatic Treatment in MS
SPASTICITY: (1) baclofen, tizanidine, dantrolene, botox, PT