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MS
Clinical Medicine II
| Question | Answer |
|---|---|
| What is multiple sclerosis | autoimmune d/o affects the CNS, destruction of myelin |
| Does MS ↓ survival | no but significantly impacts QOL |
| Where is MS more commonly seen | Further away from the equator MC in females 2:1, Peak incidence ~40’s |
| What are the RF’s for MS | Geography, Age, Environmental influences at young age, Genetics: vit D deficiency? |
| What are the proposed causes of MS | Autoimmune: T-helpers are iniciators, Microbial: something starts the autoimmune response, Chronic Cerebrospinal Venous Insufficiency (CCSVI) theory, |
| What is the CCSVI theory | obstructed drainage in veins of brain and spinal cord→reflux back up to brain, causes immune response |
| Where do MS lesions occur | white matter in the CNS (brain/spinal cord) |
| What cells lead to destruction of myelin, how? | CD4+ cells, cross BBB and produce cytokines→inflammation & damage |
| Where does the “sclerosis” part of MS come from | Macrophages remove the degenerated areas→gliosis, shrunken areas of demylenation called a plaque or sclerotic area |
| Do the axons get damaged | not from the dz process, but the scar that forms can damage under lying axon fibers |
| What is the clinical presentation of MS | varies for every pt, depends on where the lesion is |
| What are primary sxs | direct consequence of conduction produced by demyelination and axonal damage |
| What are secondary sxs | complications from 1 sxs, Eg. Frequent UTI’s d/t urinary retention |
| What are tertiary sxs | relate to the effect of dz on pt’s everyday life. Emotional, psychological and social effects eg. Self cath d/t urinary retention |
| What are common sxs of MS | vision or parethesias often w/ pain. All are different! |
| Objects in the visual field appear to oscillate | oscillopsia |
| Neck flexion causes an electric shock to spine | Llhermitte’s sign |
| Though sxs may be very fluctuant, what is a sign for MS | the neuro sxs worsen by heat, humidity or hot bath |
| What does the clinical course look like | Unpredictability and varability, BUT characterized by exacerbations and remissions |
| What is the Relapsing/Remitting MS characteristics | 85%, discrete attacks evolve days-wks, often completely recovery w/I weeks to months, slowly ↓ recovery, and sometimes doesn’t completely return to baseline |
| What are Secondary progressive MS | (begins like RRMS) eventually experience steady deterioration of fxn unassociated w/ acute attacks |
| What are characteristics of primary progressive MS | not experience attacks, but staed y functional decline, usually later in life but disability develops faster (40yo) |
| Characteristics of Progressive/Relapsing MS | steady deterioration but with acute attacks |
| How do we distinguish b/w PRMS and PPMS | indistinguishable |
| How do we diagnose MS | >2 episodes, CNS white matter, Sxs >24 hrs, separated by at least 1m, present on nero exam, second sign intrathecal IgG synthesis or MRI |
| What is characteristic in 90% of pt’s w/ MS | ↑igG in CSF protein is slightly elevated |
| What is a sign of an active lesion | Gadolinium enhancement contrast |
| What are ways to dx MS | MRI, Evoked potentials, CSF |
| Are size of lesions consistent w/ neuro deficit? | no, depends on where lesion is for effects |
| What is seen in CSF w/ pt’s w/ MS | mononuclear cell pleocytosis (↑lymphocytes), ↑IgG, protein ↑ slightly |
| DDx of MS | Lupus, CNS vasculitis, Sarcoidosis, Syphilis, HIV, lyme dz, CVA/TIA, nutritional d/o eg. B12 deficiency |
| Tx of MS | prevention o f relapses, tx sxs is key, tx acute attacks |
| If age of onset <40 yo whats the prognosis | better than later in life |
| What are favorable prognosis | <40, female, optic neuritis or sensory sxs as initial sxs, low attack frequency, type: relapsing/remitting |
| What measures neurological impairment of MS | Kurtzke Expanded Disability Status Score |
| What are issues we need to address w/ pt and family with dx of MS | life adjustments: grief, depression→suicide risk, financial and vocational, sexuality, family and pregnancy issues |
| Focus of rehab | improving and optimizing fxn |
| What are 5 types of rehab | PT, OT, Speech therapy, Cognitive rehab, vocational rehab |
Created by:
becker15
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