Teaching Pearls:

• Cardiac Resynchronization Therapy (Biventricular pacemaker + AICD) can reduce mortality in patients on optimal heart failure medications with left ventricular ejection fraction of 35% or below, New York Heart Association functional class III or IV heart failure, and a QRS interval of 120 msec or greater.
• INO (Intranuclear ophthalmoplegia): Defect in the medial longitudinal fasciculus causing a problem with adduction of opposite eye and nystagmus on the ipsilateral eye.
• Lhermitte’s sign – shocking sensation down the neck to the body upon flexion of the neck.
• Dysdiadochokinesia- Inability for bilateral fast repetitive motion. Suggestive of cerebellar pathology.
• Scanning speech – “staccato speech”. Ataxic dysarthria. Words are broken up into several syllables, often separated by noticeable pauses
• Optic Neuritis – presents with pain with eye movements, blurry vision, mononuclear blindness, or pupillary defects. Afferent pupillary defects.
• Illness Script for MS: Young women with neurologic symptoms separated in time and space. Demyelinating plaques found in CNS white matter – ovoid-appearing demyelinating plaques that radiate from corpus callosum (Dawson’s fingers). Central (not peripheral) CNS disease.
  • Uhthoff phenomenon: worsening of symptoms in heat, affects nerve conduction
• Treatment for acute MS flare: Solumedrol 1g x 3-5 days, prednisone therapy taper 10-14 days, begin immuno-modulating therapy with either Interferon- beta or Glatiramir.

Illness Scripts: