Neuro shelf - demyelinating diseases of CNS

  1. MS
    peak incidence ages 20-30, more common in northern latitudes, higher prevalence in white polulations

    multiple white matter lesions separated in space and time. commonly corticospinal tract signs (weakness and spacticity), cerebellar problems (intention tremor and ataxia), sensory abnormalities (paresthesias, loss of vibration and proprioception), and bladder dysfunction

    optic neuritis common presenting symptom - painful loss of visual acuity in one eye, blurry vision, loss of color discrimination. optic disc may be swollen, red desaturation indicates past ON

    transverse myelitis - area of inflammatory demyelination in the spinal cord, usually partial lesion. bay be unilateral or bilateral weakness or sensory loss below lesion

    internuclear ophthalmoplegia (INO) - dysfunction of the MLF leads to inability to adduct one eye when looking to opposite eye (very characteristic of MS)

    Lhermitte's sign - tingling, electric sensation down spine when pt flexes in the neck

    Uhthoff's phenomenon - worsening symptoms in heat
  2. predictors of good prognosis for MS
    young age at onset, female sex, rapid remission of initial symptoms, mild relapses that leave little or no residueal deficits, presentation with sensory symptoms or optic neuritis rather than motor symptoms
  3. Dawson's fingers
    on sagittal MRI - foci of demyelination spreading upward from corpus callosum
  4. CSF finding in MS
    oligoclonal bands that reflect intrathecal production of IgG antibodies by plasma cell clones
  5. acute disseminated encephalomyelitis
    (ADEM) - monophasic illness leading to areas of CNS demyelination following viral infection or vaccination

    lesions of multiple and more patchy, bilateral, and confluent than MS. Predilection for posterior cerebral hemispheric white matter. Behavioral and cognitive abnormalities are often seen (less common in MS)

    CSF - lymphocytic pleocytosis, no oligoclonal bands

    neurologic recovery nearly complete, may tx with IV corticosteroids
  6. PML
    demntia, focal cortical dysfunction, cerebellar abnormalities
  7. post-organ transplant leukoencephalopathy
    acute confusional state with cortical visual loss (blindness with preserved pupillary reactivity)

    due to immunosuppresants such as tacrolimus and cyclosporine
  8. hypertensive leukoencephalopathy
    due to sudden increase in BP, acute confusional state, seizures, headaches, vomiting, papilledema with retinal hemorrhages and hard exudates. Maybe cardiac ischemia and hematuria
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Neuro shelf - demyelinating diseases of CNS