MS PBL

Question 1

what is pathology of MS

Answer 1

multifocal, immune mediated inflammation that results in demylenation and axonal damage

Question 2

2 types of damage that can occur to a nerve

Answer 2

inflammation/demylenation - reversible

axonla damage - irreversible

Question 3

what is mech of recovery in MS

Answer 3

remylenation with smaller mylen segments leads to slowed conduction speeds

Question 4

what is epidem. of MS

Answer 4

3:1 females - caucasian, between 15-50

Question 5

3 subtypes of MS

Answer 5

1. relapsing remitting - 85%
2. primary progressive
3. prgressive relapsing

Question 6

what is first attack in RR types

Answer 6

clinically isolated syndrome

Question 7

what is onset, duration and recovery of CIS

Answer 7

onset - days

duraiton: weeks
recovery: complete

Question 8

3 most common intial Sx

Answer 8

1. sensory Sx in LIMBs only
2. optic neuritis
3. acute weakness

Question 9

what is seen on MRI in CIS

Answer 9

multiple lesions indistiguishable from MS

Question 10

what happens to MS pattern over time

Answer 10

moves from RR subtype to secondary porgressive

Question 11

what does “multiple” in MS apply to

Answer 11

multiple in space and time

Question 12

common MS Sx (7)

Answer 12

1. fatigue
2. impaired vision
3. brainstem : diplo, vertigo,
4. cerebellar: ataxia, incoordination
5. sensory
6. motor weakness
7. sphyncter

Question 13

avg. time to progresison from RR to SP

Answer 13

6-10 years

Question 14

key diagnostic factors in MS

Answer 14

clinical
bloods to rule out other
MRI and CSF sensitivity increases with time

Question 15

what type of MRI to use

Answer 15

cranial more sens. that spine, but over 50 spinal is more specific

Question 16

what is seen in MS MRI

Answer 16

95% abnormal in MS

• multiple white matter lesions around lateral ventricles
• usually irregular shape

Question 17

2 times when spinal MRi is good

Answer 17

1. old PTs (>50)

2. when cranial was normal

Question 18

when else might one see MRI lesions

Answer 18

1. small vessel disease

2. other stuff

Question 19

5 times to questions MS diagnosis

Answer 19

1. age out of 15-60
2. race
3. clinical - findings ascribable to single lesion
4. course - steady
5. CSF and MRI persistently normal over years

Question 20

time from onset to use of a cane

Answer 20

30 years - worse in PP

Question 21

bad prognostic factors

Answer 21

1. high relapse rate
2. short interval
3. male
4. incomplete recovery
5. older age at onset

Question 22

goals of disease modifying treatments

Answer 22

1. improve recovery form acute attacks
2. prevent attacks
3. prevent onset of progressive
4. halt progression

Question 23

what about steroids

Answer 23

NOT effective in preventing or slowing progresison and have bad SEs

Question 24

when are disease modifying treatments indicated

Answer 24

only durinr RR phase