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Neuro Exam 1 – MS Questions With Complete Solutions
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Neuro Exam 1 – MS Questions WithComplete Solutions
multiple sclerosis correct answer: lMultiple lesions with
sclerotic plaques throughout the CNS- brain, optic nerve,
brainstem, and SC
lIncidence increases from teens to age 35 and then decreases
lPrevalence varies in different populations
-Females 2 X males
-Caucasians
Plaques in the nervous system may not show up if the pt is
currently in an inflammatory process because they are really
scars that show up in the CNS after the inflammation
Initial dx: optic nerve is commonly involved and useful for dx
Characterized by intermittent demyelination caused by the
destruction of oligodendrocytes
Demyelination - causes scarring and hardening of the nerve
fibers causing sclerosis
Causes weakness, numbness, pain, vision loss
More systems get worse as it progresses because more systems
are effected
Early symptoms: vision changes (blurred vision, blind spots,
red/green color changes, one eye blindness) and weakness
Exacerbations and remissions are common
Most have a normal lifespan
distribution correct answer: increased in AA and Asians esp in
northern US
•Caucasian ethnicity in these high risk areas
•May be something environmental
,•Vitamin D deficiency
•Unknown reasons
•Regardless of genetics or previous geographical risk, if the pt
moves before age 15 then they take on the new area's risk so we
know there is something about geography but don't know why
high risk - parts of europe, upper US and Canada
etiology correct answer: lProbable autoimmune basis
lGenetic predisposition
-Significantly greater chance of getting MS if a parent has it
-Child has a greater susceptibility for MS, it is not passed on
lEnvironmental influence - possibly viral
lVitamin D deficiency implicated
-Geographic link
Not a direct linked genetic predisposition but there is a trait in
the families so higher risk
white spots correct answer: these are classic representation
May not be in cerebral hemispheres, can be anywhere within
CNS, may scan for areas directly related to clinical symptoms
Immune response that triggers the T-cells that activate the
autoantigens that produce an autoimmune cytotoxic effect in the
CNS that causes the demyelination then have acute
inflammation and then eventually the inflamed myelin can't
repair itself and the plaques form where the myelin once was
MRI correct answer: One patient scanned overtime
More progressive form of MS
MRI with sclerotic areas and loss of brain tissue
Variety of symptoms and severity
, A: multiple lesions and white matter around ventricles
B: 9 months later, number and size of lesions has increased with
increased symptoms
C: MRI with enhancement that shows small lesions
D: parasagittal MRI showing lesions and holes (dark areas)
formed from chronic plaques
clinical course correct answer: lUnpredictable course
lDisease process progressive throughout course but symptoms
may have periods of relapse and remission
lFrequently starts with visual impairment - optic nerve is
selectively attacked
-Visually problems tend to clear up toward end stages of MS
lFour basic categories
Most varied clinical course of any neuro disease
Progressive - symptoms getting worse throughout entire of life
MS pts generally have a normal lifespan - goal is to keep
symptoms at bay as long as possible so they can stay as
functional as they can
Benign or malignant form: malignant is more rare but have rapid
and continuous progression symptoms whereas benign is where
the symptoms vary but the lesions remain
~60% of MS pts have symptoms with optic nerve changes at
some point; ~15% of pts it is the first symptom so this lead to
optic neuritis as a top sign for MS esp if there is changes with
the spinal fluid
relapsing remitting correct answer: main category of MS;
majority of pts with MS have this type (more than ½, 55-80% of
pts); acute attacks with full or partial recovery in between
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