Name the Lesion
Lower extremity loss of sensation or weakness
Spinal Cord
How is MS diagnosed? (clinical, labs or both?)
Clinically based dx supported by imaging and CSF analysis
What is the geographic region where MS is most common ?
More common in northern latitudes.
What is the classic Charcot triad of MS? (hint SIIIN)
Scanning speech (sound drunk)
Intention tremor
Incontinence
Internuclear ophthalmoplegia
Nystagmus
chronic neurologic condition of white matter lesions separated by time (acute and past symptoms) and space (different parts of the CNS affected), marked by unpredictable relapses with long asymptomatic remissions.
MS
Splasticity, increased DTRs, Muscle spasms, Extensor plantar response, weakness with shoulder abduction, finger extension, foot dorsiflexion, hip/knee flexion
UMN dysfunction
What is the most important diagnostic CSF finding for MS?
The detection of oligoclonal IgG bands with isoelectric focusing
What is the pathogenesis of MS?
While the cause is unknown, multiple sclerosis is characterized by autoimmune demyelination of oligodendrocytes in the CNS, histologically characterized by sharply defined area of myelin loss with relative preservation of axons.
What is Uhthoff's phenomenon ?
Symptoms may worsen with heat (e.g., bath, warm weather) because heat further slows the rate of conduction via demyelinated nerves.
areas of oligodendrocyte loss and reactive gliosis
Periventricular plaques
Sexual dysfunction, Bowel motility problems, urinary incontinence
Autonomic dysfunction
What is the gold standard for dx of MS?
MRI
What gender is more likely to develop MS ? What age?
Women , between 20 and 30 years of age
What is usually the first sx of MS and how does it present?
Optic neuritis is usually first sign and can present with blurry vision or sudden painful loss of vision.
Most common subtype of MS , clearly defined relapses of disease symptoms followed by complete recovery.
Relapsing-Remitting
Bilateral internuclear ophthalmoplegia: unable to move eye medially on lateral gaze
Medial longitudinal fasculi (MFL )
What will MRI reveal in MS?
periventricular plaques
What is the genetic risk factor for developing multiple sclerosis?
HLA-DR2
(firecracker says HLA-DRB1) Will take either!
What drugs can be used to limit the progression of MS ? We name 3. Extra point for MOA. Best 2/3.
Beta-Interferon (therapy increases integrity of blood-brain-barrier reducing the relapse rate by ~ 30%-40%. Check CBC and liver function tests since interferon therapy can lead to leukopenia and transaminitis.)
Natalizumab (monoclonal antibody that binds α4-subunit of integrins on WBCs disrupting interaction with VCAM-1 (vascular cell adhesion molecule-1) and MAdCAM-1 (mucosal addressin cell adhesion molecule-1) ultimately preventing WBCs from exiting the blood vessels to subjacent inflamed tissues)
Glatiramer (immunomodulatory mechanism of action that involves binding to major histocompatibility complex molecules and consequent competition with various myelin antigens for their presentation to T cells.)
radiographic feature of demyelination characterized by periventricular demyelinating plaques distributed along the axis of medullary veins, perpendicular to the body of the lateral ventricles and/or callosal junction.
Dawson fingers
Scanning speech (Sound drunk)
Brainstem
chemical substance used in magnetic resonance imaging (MRI) scans for diagnosing MS
Gadolinium
Most common demyelinating disease in the whole wide world
MS
How does pregnancy affect patients with MS?
Decreased relapse frequency
medical sign observed during the swinging-flashlight test whereupon the patient's pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye.
Marcus Gunn Pupil