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Nur 265 - Neurological questions fully solved & updated
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Nur 265 - Neurological questions fully solved & updated
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Nur 265 - Neurologicalquestions fully solved &
updated 2024-2025
Multiple Sclerosis - answer Incidence/Prevalence
• Gender: affects more women than men
• Age: highest incidence 20-40 yrs. Known as disease of the young
• Incidence: about 500,000 people in the US are currently affected.
Incidence in the first degree relatives of a person with MS is 15%.
Life expectancy is about 85% of normal persons (or about 35 years
after onset of symptoms)
• Geographics: seen more in colder climates (north eastern, Great
Lakes and Pacific north-western states as weel as Canada)
Multiple Sclerosis - answer Causes
• Unknown but theories include
• Viruses
• Immunologic factors
• Genetics
• Environmental Factors
Multiple Sclerosis - answer Pathophysiology
• In MS demyelination is scattered irregularly throughout the CNS.
The plaques (patches in involved areas) become sclerosed,
interrupting the flow of nerve impulses and result in a variety of
manifestations depending on which nerves are affected
• The area most frequently affected are the optic nerves, pyramidal
tracts, the cerebrum, then brain stem, cerebellum and spinal cord
,Multiple Sclerosis - answer Remission and Exacerbations
• Exacerbations: new symptoms appear and existing ones worsen.
• Remissions: symptoms decrease or disappear
• Relapses: may be associated with periods of emotional and
physical stress. With repeated exacerbations of the disease,
damage to the axons become permanent
• Plaques: do not produce serious symptoms and patients are not
seriously incapacitated but have long periods of remission between
episodes
Multiple Sclerosis - answer Types
• Relapsing-Remitting MS (RRMS): 80-85% of cases with complete
recovery between symptomatic exacerbations.
- Does not progress between lapses.
- Course of disease mild or moderate depending on severity of
disabilities.
- Relapses develop over 1-2 weeks and resolve over 4-8 months.
Some may progress to SPMS
• Secondary Progressive MS (SPMS): begins with RRMS that later
becomes more progressive. Attacks and partial recoveries may
continue to occur
Multiple Sclerosis - answer Types
• Progressive-Relapsing MS (PRMS): 5% of patients.
- Absence of periods of remission and the patients condition does
not return to baseline.
- Progressive, cumulative symptoms and deterioration occur over
several years
• Primary-Progressive MS (PPMS): 10-20% of patients.
- Steady and gradual neurologic deterioration without remission of
symptoms.
- The patient has progressive disability with no acute attacks.
, - 40-60 years of age at onset of the disease
Multiple Sclerosis - Manifestations - answer Respiratory:
• diminished cough reflex, respiratory complications (pneumonia,
etc)
Musculoskeletal/Motor:
- stiffness of extremities especially legs. (OFTEN reported by
patient)
- fatigue: very common, 70-90%
- limb weakness (or "heaviness")
- ataxia (clumsy, shaky, uncoordinated)
- spasticity of extremities: flexor spasms may awaken patient
- increased reflexes: DTR, clonus, positive Babinski
- Intention tremor: (tremor when performing activity)
- dysmetria
- loss of abdominal reflex
- muscle atrophy
- talipes equinus: foot drop
- dysarthria with slurred speech: (CN III & XII. patient seems to
search for words)
Multiple Sclerosis - Manifestations - answer Sensory: visual
disturbances due to lesions on the optic nerve
- blurring or cloudy vision
- diplopia, eye pain, vertigo
- nystagmus, numbness
- visual field deficits: patchy blindness, blind spots etc due to optic
neuritis
- tactile sensory deficits: hands and feet
- paresthesias
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