Multiple Sclerosis
Terms
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- MS predominantly affects the myelin of which system?
- Central nervous system
- What type of cells make myelin in the CNS? A single oligodendrocyte myelinates how many neurons?
- Oligodendrocyte. 40-100.
- The Schwann cells myelinate how many axons? What types of nerves does it myelinate and not myelinate?
- A single axon. Cranial and spinal nerves; not olfactory and optic.
- Where does destruction of myelin occur in MS? What stain is used on myelin?
- Perivenular areas. Luxol fast blue PAS
- What are Dawson's fingers?
- Finger-like projection areas of demyelination.
- How does demyelination in viruses differ from that of MS?
- It is centered around the oligodendroglia. (PML)
- What is a circumscribe area of demyelination called? What does it consist of?
- a "plaque" with demyelination and inflammatory cells.
- What types of cells are in the inflammatory area? Which cells secrete local Ig's? Where do the Ig's accumulate?
- T lymphocytes, macs, and plasma cells. Plasma cells. In the CSF.
- What contributes to the developmt of neurologic dysfxn?
- Axonal injury
- What is a major effect of demyelination? What are the effects on a person that may result?
- Cessation of nerve conduction. Loss of vision, anesthesia, or paralysis.
- This may cause non-organic symptoms in pt's making them seek psychiatric eval?
- Anomalous (abnormal) conduction b/t neighboring axons.
- What are the "shock-like" sensations tha some may experience in MS? When do they normally occur?
- L'Hermittes phenomenon. Sensations traveling from the region of the spinal cord to upper and lower extremities. Upon neck flexion.
- What age group does MS normally occur in? Who usually gets it, M or F?
- 3rd-5th decade. females 3:2(male).
- What is the vision loss in one eye called? What is a Marcus-Gunn pupil?
- Central scotoma. THe pupil has a delayed sluggish response to light.
- What is another name for central scotoma?
- Retrobulbur neuritis.
- What does demyelination of the MLF cause? What is the effect? What is the correct dx. for this problem?
- Diplopia. Failure to adduct for horizontal lateral gaze. Internuclear ophthalmoplegia
- Motor involvement is assoc'd with what types of signs?
- UMN: spasticity, hyperreflexia, and extensor plantar responses (pos. Babinski)
- What type of sensory disturbance can occur?
- Tic doloreaux - trigeminal neuralgia.
- An inner ear infection may actually be what? Cerebellar dysfxn results in what symptoms?
- Vertigo. Ataxia and tremors.
- 85% of pt's display this type of MS with variable amt's of time b/t exacerbations and relapses?
- Relapsing-remitting course
- Half of the R-R course will evolve into this type? 10% will follow this insidious course which is called?
- Secondary progressive. Primary progressive.
- What labs confirm the dx of MS?
- Non! All clinical.
- What else may MS appear to be? (Diff. dx's)
- Vasculitis of the CNS, sarcoidosis, infections, tumor, etc.
- What lab's may aid in dx?
- CSF IfG is elevated (albumin normal), oligoclonal bands, evoked responses, MRI to see plaques
- What genetic HLA haplotypes tend to be represented in this disease?
- HLA A3, B7, Dw2, DRw3
- What climate does it usually occur in? When does one acquire the disease?
- Temperate. By age 15.
- What is used to treat MS?
- Corticosteroids (immunosuppression), &cyclophosphamide
- What is used for a 3 day tx of an acute exacerbation?
- A high dose IV of methylprednisone.
- What drug has been found to dec. the freq. of new exacerbations by 33% and to dec. new MRI lesions?
- Interferon beta
- What drug is used to treat relapsing MS? What chemotherapeutive drug may also treat the relapsing or progressive pt? What is its side effect?
- Glatiramer acetate (Copaxone). Novantrone (mitoxantrone). Cardiotoxicity.