Neurology Multiple Sclerosis
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| Underlying Factors of MS | Infectious agent, genetic predisposition, Environmental Factors, abnormal immunologic response.
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| MS definition | an inflammtory demyelinating disorder of the CNS that affects physical, cognitive, psychologic function. Autoimmune. Axonal loss (which is not repairable)
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| MS epidemiology | Mean age of onset: 20-40 years, F:M=2-3:1
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| Common manifestations of MS | optic neuritis, transverse myelitis, paresthesias, ataxia, weakness or incoordination, spasticity, cognitive impairment
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| MS Abnormalities may be found on _______ before symptoms are present | MRI
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| Optic neuritis symptoms | Pain behind eyes, can't move eyes.
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| Onset of MS | comes on over a day or two, may come on and off for weeks. 85% is relapsing MS
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| How does MS affect the brain? | Causes faster shrinkage
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| Secondary Progressive MS | Relapsing --> Progressive MS (occurs after 10 years in 50% of cases)
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| Therapy is most effective in which type of MS? | Relapsing MS. This is early in the disease when the autoimmune inflammation is the major concern. This is what meds can work on
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| Benign MS | Complete recovery between relapses. Uncommon
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| T1 MRI | CSF is black, "black hole" (CSF fluid)
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| T2 MRI | CSF is white. This scan is followed up with a FLARE scan which then turns all of the normal water back to black
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| Areas of active dye | an active lesion right now
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| Diagnosis of MS | Hx: involvement of the CNS "separated in space and time". Exam - evidence of "dissemination in space" CNS manifestations. MRI lesions or plaques, Evoked potentials, CSF - evidence of oligoclonal bands or increased IgG index.
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| Evoked potentials measures | Slowing of information conduction
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| Location for typical MS lesions | Alongside the ventricles (usually oval and perpendicular to it) and in the corpus collosum
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| MS MRIs reveal | Larger ventricles and shrunken brain, and white spots
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| Which is permanent, Demyelination or axonal loss? | Axonal loss.
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| Treatment Options for Relapsing forms of MS | Disease-modifying treatments (IFNs and glatiramer acetate), Immunosuppressive drugs, Corticosteroids. Safe, moderately effective, decrease relapses by 1/3
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| What does the CSF show in MS patients | Oligoclonal bands or increased IgG index
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