12. Multiple Sclerosis Flashcards
What is optic neuritis?
Unilateral visual loss lasting less than 2 weeks
Starts with red vision
Pain on eye movement
Affected eye dilates in response to light
What are the effects of MS plaques in the brain stem or cerebellum?
Facial palsy
Ataxia, diplopia
Trigeminal neuralgia
Internuclear ophthalmoplegia
What is internuclear ophthalmoplegia?
Affected eye is fixed and other has nystagmus when trying to look towards contralateral side
What are the effects of MS plaques in the spinal cord?
Numbness, urinary/faecal incontinence
Sexual dysfunction
Weakness, increased tone±clonus
Brisk reflexes
What is Brown-Sequard syndrome?
Occurs when 1/2 of cord is damaged
Loss of motor, vibration, proprioception and deep touch ipsilateral
Loss of pain, temperature and light touch contralateral
What are the effects of MS plaques in the cerebral cortex?
Cognitive impairment
Hemiparesis
Seizures
Encephalopathy
What is a clinically isolated syndrome in MS?
1 event suggesting demyelination and physical signs on exam
Lasts >24, not all progress to MS
What increases the risk of a clinically isolated syndrome progressing to MS?
Abnormal MRI
Asymptomatic spinal cord lesion
Unmatched oligoclonal bands in CSF
What is meant by ‘unmatched’ oligoclonal bands?
Raised in CSF but not in serum
How is it proved that MS is disseminated in time?
Difference on a follow up MRI
New lesions enhanced with gadolinium present with old lesions at same time
or if disseminated in space with unmatched oligoclonal bands
How is primary progressive MS diagnosed?
1 year of disease progression with 2 of:
Disseminated in space on brain MRI
DIS in cord
Unmatched oligoclonal bands
What are the first line disease modifying drugs in MS?
Interferon
Glatiramer acetate
Dimethyl fumarate
Teriflunomide
