Morning Report 9/30/15 – Multiple Sclerosis

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:

Epidemiology Timing Neuro/Specific Factors
Multiple Sclerosis Female, 20-40 yearsF:M 3:1, most common non-traumatic neurologic disease Subacute Separated in time and spaceRelapsing-Remitting (85%)

1⁰ Progressive

2⁰ Progressive

Neuromyelitis Optica F:M 10:1 Days/Acute Bilateral Optic Neuritis, Associated Transverse MyelitisNo plaques in the brain
Transverse Myelitis Children, Young AdultsBimodal Distribution

Viral illness preceeding

Acute Bilateral weakness before a spinal segment, upper motor signs, bladder/bowel dysfunction
ADEM Children/Young AdultsPreceeding illness 1-3 weeks prior Acute Distinguishing characteristics: encephalopathy, fevers, headache

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