123 - multiple sclerosis part 2

1. total volume of the T2 weighted signal abnormality shows significant correlation with clinical disability

2. MRSI can quatitate molecules like N acetyl aspartate which is marker for axonal integrity

3. mononuclear cell pleocytosis is seen in CSF

4. pleocytosis of greater than 75 suggested some other diagnosis rather than MS

5. increased level of intrathecally synthesized Ig G

6. protein concentration of greater than 100 mg/dl suggests some other diagnosis rather than MS

7. two or more oligoclonal bands are seen in CSF

8. patients with optic neuritis at onset have good prognosis

9. patients with sensory symptoms at onset have good prognosis

10. complete recovery from early attacks favour good prognosis

11. patients less than 40 years of age have good prognosis

12. women have good prognosis when compared to men

13. patients with RRMS course have good prognosis

14. patients with less than two relapses in the first year have good prognosis

15. progressive disease has good prognosis

16. presence of truncal ataxia has bad prognosis

17. if the symptoms begin from childhood then the patient has bad prognosis

18. presence of action tremor indicate bad prognosis

19. presence of pyramidal symptoms indicate bad prognosis

20. pregnant MS patients experience fewer attacks than expected ( especially third trimester )

21. more attacks experienced at 3 months post partum

22. when considered pregnancy as a whole ( 9 months pregnancy + 3 months postpartum ) the overall disease course is unaffected .

23. interferon beta 1 A , interferon beta 1 B, glatiramer acetate, mitoxantrone, natalizumab are the drugs used in the disease modifying therapies for relapsing forms of MS

24. separate attacks of acute optic neuritis and myelitis indicate NEUROMYELITIS OPTICA ( NMO ) rather than MS

25. brain stem, cerebellar and cognitive involvement indicate MS rather than NMO .

26. focal enhancing region of swelling and cavitation over 3 or more spinal cord segments in MRI favour a diagnosis of NMO rather than MS

27. association with systemic autoimmune disease like SLE favours NMO rather than MS

28. if the brain MRI is normal it indicates a diagnosis of NMO rather than MS

29. fulminant demyelinating acute MS without remissions leading to death within 1 to 2 years is called as MARBURG’S VARIANT .

30. presence of widely scattered small foci of perivenular inflammation and demyelination is characteristic of Acute Disseminated EncephaloMyelitis (ADEM )

31. ADEM follows smallpox and rabies vaccine

32. introduction of live measles vaccine has dramatically reduced the incidence of ADEM and now ADEM is mostly associated with chicken pox rather than measles infection .

33. meningismus, drowsiness, coma or seizures indicate ADEM rather than MS

34. bilateral optic nerve involvement is characteristic of ADEM

35. treatment of steroids, plasma exchange and IV Ig .

36. treatment for multiple sclerosis is Interferon BETA .

122 - multiple sclerosis part 1

1. sparing of the peripheral nervous system ( PNS ) is typical of Multiple sclerosis ( MS ) .

2. MS is not associated with any systemic illness.

3. CNS myelin is typically involved.

4. the disease has a typical waxing and waning course .

5. perivenular cuffing is present

6. T cells and macrophage inflammation is present

7. disruption of blood brain barrier

8. there is no disruption of vessel wall

9. MS is thrice as common in women as in men

10. age of onset is typically between 20 and 40 years

11. the disease can begin as early as 2 years and as late as 8^th decade .

12. prevalence of MS increases with increasing distance from equator

13. MS is polygenic

14. the most important MS susceptibility region is MHC on chromosome 6p21

15. DR2 is associated with MS

16. anti MOG ( myelin oligodendrocyte glycoprotein ) antibodies are predictive of future MS .

17. oligoclonal antibody is seen in MS

18. TH1 cytokines TNF, IL2 and IFN gamma are central to MS pathogenesis .

19. MS is common in high socioeconomic status , the cause being delayed exposure to infectious organisms .

20. Theiler virus model is the best studied experimental model of MS

21. HHV 6 and Chlamydia pneumoniae can be associated with MS

22. sensory loss is the most common initial symptom of MS

23. exercise induced weakness is characteristic symptom of MS

24. Visual symptoms in MS are mostly monocular .

25. periorbital pain aggravated by movement precedes visual loss

26. UVEITIS IS RARE

27. lesion in ipsilateral MLF leading to impaired adduction of one eye ( internuclear opthalmoplegia ) is common .

28. bilateral internuclear opthalmoplegia is particularly suggestive of MS

29. horizontal gaze palsy + internuclear opthalmoplegia is called ONE AND HALF SYNDROME .

30. acquired pendular nystagmus is a common gaze disturbance in MS

31. UHTHOFF’S SYMPTOMS : neurological symptoms in MS getting aggravated by elevation of body’s core temperature is called uhthoff’s phenomenon .

32. the most common disease course in MS is relapsing remitting multiple sclerosis ( RRMS )

33. leakage of gadolinium dye on MRI is an early marker of MS

34. lesions in MS on MRI are frequently oriented perpendicular to ventricular surface

35. lesions of anterior corpus callosum on MRI are common in MS