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77 Cards in this Set
- Front
- Back
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What is the median onset of age for MS?
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32 years.
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What gender is MS more common in?
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Females.
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What is the environmental trend for MS based on Kurtzke's theory?
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The further north of the equator you went, the more cases of MS there were.
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What is the genetic MS trend based on Bulman & Eber's theory?
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Higher incidence of MS in patients of Scandinavian descent.
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What were the conclusions from Poser's theory?
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Disease was probably genetically linked and originated from the Vikings.
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The cause of MS is linked to what 2 things?
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Genetics & Environment.
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A person's specific immune system make up plays what role in MS?
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Genetic Component.
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These act at or before puberty and may be environmental such as exposure to certain infections, vaccines, and perhaps diet.
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Initiators
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Genetics + Initiators=What?
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MS Trait
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Genetic or environmental factors that act on MS trait are called what?
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Enhancing vs. Protecting
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What does the pathology of an MS patient in the brain present as?
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Sclerotic plaques.
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What are sclerotic plaques the result of?
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An initial inflammatory response.
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Explain the MS disease process.
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Inflammatory response-->infiltration of WBCs into CNS-->Demyelination, Axonal Loss
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When do demyelination and axonal loss occur?
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Demyelination & axonal loss occur together, early in disease.
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What are the 3 different forms of MS that we need to be aware of?
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1.Primary Progressive
2.Relapsing & Remitting 3.Secondary Progressive |
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-Least common form of MS
-MS disability, progresses slowly over time -Progressive painless myelopathy, pt.s often present with trouble walking |
Primary Progressive
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-MS attack, followed by regression
-Eventually, the symptoms will not completely go away after each relapse & will slowly add up leading to diability. |
Relapsing & Remitting
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With what type of MS is anti-inflammatory treatment used?
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Relapsing & Remitting
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During MS relapses, what is the difference b/w a patient's symptoms and MRI?
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Inflammation will come & go but MRI will show that it does not really go away during remission.
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What causes secondary progressive MS?
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This degeneration is NOT believed to be a result of any ongoing inflammatory response-->we have not figured out what that driving force is.
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This form of MS is a continuation of the relapsing form.
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Secondary Progressive
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What percentage of patients with relapsing episodes will develop this secondary progressive phase within 25-30 years of the onset of the symptoms.
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90% of patients
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In what phase of MS does the patient start to lose function between relapses?
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Secondary Progressive
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How is Secondary Progressive MS treated?
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It is much harder to treat-->can't be stopped once it gets to this point.
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What are the classic symptoms of MS?
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1.Sensory
2.Vision Loss 3.Fatigue 4.Afferent Pupillary Defect |
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What exacerbates MS symptoms?
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Extreme heat.
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What is the #1 sign of MS, but the least specific?
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Sensory Loss
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What is a specific clincial symptoms for MS?
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Vision Loss
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What is the usual cause of vision loss in MS patients?
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Optic Neuritis.
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What tract does MS particularly affect in a younger person that causes double vision?
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MLF
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What does the MLF connect?
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MLF connects CN VI in the pons with CN III of the opposite eye up in the midbrain.
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What happens when the MLF gets demyelinated?
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Patient's eyes won't move together.
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What specific change occurs when the MLF is demyelinated?
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When the patient looks to the left, the right eye won't aDduct, and when they look right, the left eye won't aDduct.
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When MLF demyelination is symmetrical, what are the symptoms?
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Both eyes have trouble with adduction when looking to the opposite side.
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When both eyes have trouble with adduction when looking to the opposite side, what is this called?
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Bilateral Internuclear Ophthalmaplegia (Bilateral INO)
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If you see a bilateral INO in a young patient, what do they most likely have?
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MS
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How must one look for MLF demyelination?
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They must look very quickly from side to side b/c slow following will not elicit an aDduction delay.
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What 3 ocular symptoms are huge signs of MS?
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1.Afferent pupillary defect
2.Optic Neuritis 3.Bilateral INO (diplopia) |
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Are ptosis and 3rd nerve palsy indicative of MS?
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NO
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A slow rocking motion of the eye, typical of central vestibular disorders, caused by MS--is called what?
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Pendular nystagmus
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What is the most common complaint a physician will hear from MS patients?
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Fatigue
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A dilation of the pupils when moving the light from the good eye, to the one with the afferent defect is called what?
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Afferent pupillary defect.
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If one sees a female patient with painful loss of vision in one eye and MRI shows inflammation (or enhancing signal) around the nerve, what is this case of? What disease process is suspect?
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Retrobulbar optic neuritis, disease is MS
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Attacks separated in time and space refer to what criteria for the diagnosis of MS?
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Poser Criteria
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What new guidelines still agree with the "time and space" idea but also add in MRI technology?
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McDonald/International Panel Criteria
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Name the criteria:
1.separation of time and space 2.Poser + MRI |
1.Poser
2.McDonald |
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What can the spinal fluid be tested for to diagnose MS?
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Specific oligoclonal bands that are specific to the CSF and are driven by the immune response in the CNS.
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90% of MS patients will have what 2 CSF abnormalities?
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Elevated IgG level, or the presence of oligoclonal bands.
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What is the best tool used in conjuction with your physical exam findings to diagnose MS?
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MRI
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What is special about the MRI FLAIR in diagnosing MS?
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The FLAIR scan takes out the white signal from the spinal fluid-->makes the ventricles remain dark & allows you to more easily distinguish a lesion near the ventricles.
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What findings on T2 FLAIR MRI are a classic finding in MS?
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Perventricular hyperintensities.
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What dark spots on MRI represent a loss of tissue?
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T1 black holes.
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For MS, what diagnostic toll is often more accurate in terms of what is happening in the brain that the patient or your physical exam?
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MRI
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In the case of MS, does MRI predict which patient is doing better based on symptoms?
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NO-->if only MRI brain could miss lesions in the spinal cord
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MS or neoplasm?
A ring enhancing lesion without mass effect or edema=?? |
MS
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MS or neoplasm?
A ring enhancing lesion with mass effect or edema=?? |
Neoplasm
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What lesion stage shows up on MRI as a T1 black hole?
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Fibrotic stage
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What technology uses light imaging to measure the diameter of the optic nerve?
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Optical Coherence Tomography
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Classic optic neurtitis includes what other symptom besides loss of vision?
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Pain with eye movements.
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What type of cognitive impairment do MS patients have?
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Executive functioning along with fatigue, forces MS patients to quit working.
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What type of cognitive impairment do Alzheimer's patients have?
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Primarily memory issues
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What drugs cut down the risk of relapse by about 1/3rd, as well as making relapse less severe and decrease white matter lesions seen on MRI?
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Immunomodulating.
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What are bad medications for MS?
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TNF-alpha, & Interferon gamma
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What are good medication sfor MS?
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Immunomodulating & Interferon beta
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What tends to happen prior to a MS relapse?
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Viral infections
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How are pregnancy and MS related?
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During the third trimester, there seems to be some sort of protective factor against MS that is better than medication available.
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How are the 3 months post-partum and MS related?
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3 months post-partum, there is an increased risk of MS relapse.
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A patient who is currently experiencing a relapse is given what type of therapy?
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Acute therapy.
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What therapy involves mostly steroidal treatment to limit inflammation?
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Acute therapy.
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What 2 drugs are patients given that speeds the recovery but does not make the symptoms any better overall?
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Methylprednisone IV, and PO prednisone
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What type of treatment aims to prevent relapses and is primarily immunomodulatory?
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Prophylactic treatment.
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Of the prophylactic drugs, which one has the best effectiveness in terms of preventing relpases?
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All of the prophylactic drugs have about the same effectiveness.
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What advantages do drug trials have for MS?
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Just participating in a drug trial will decrease your risk of relapse.
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How many MS attacks does a patient need to make an official diagnosis of MS?
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2
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If a patient comes in and shows signs of their first MS episode that are supported by MRI, when should treatment begin?
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Treatment begins immediately.
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What form ot his disease is by the far the most common, is what we will see the most of, and as such is what we should be the most aware of?
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Relapsing/Remitting form
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What type of diagnostic criteria does MS require?
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A clinical diagnosis that requires separtion of lesions in time and space.
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