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Med School Yr 2 > 6 - Clinical Diagnosis of MS > Flashcards

6 - Clinical Diagnosis of MS Flashcards

1
Q

what is MS?

A

inflammation of the CNS following the infiltration of immune cells across the BBB

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2
Q

what does MS do to neurons in the CNS?

A

demyelinates the neurons

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3
Q

what nerves does MS affect?

A

CNS
not periphery

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4
Q

what is the epidemiology of MS?

A
  • women:men = 3:1
  • age of onset = 20-30 years
  • prevalence 1:500
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5
Q

describe the pathophysiology of MS:

A
  • T cells are activated which activates proteins that breakdown the BBB
  • APC then binds to Tcells, further activating them, and releasing chemokines
  • causes an influx of more immune cells
  • results in abtibodies attacking the myelin sheath of the neuron
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6
Q

what are the 2 roles of myelin?

A
  • propogates signals across neurons - jumps from node of Ranviers
  • protects axons - without myelin, axons become truncated and neuronal loss occurs
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7
Q

how does demyelination effect a neuron?

A
  • delays or blocks impulse
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8
Q

why might permanent disability occur in MS?

A

nerve may be sectioned or die due to demyelination

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9
Q

what are 3 broad manifestations of MS?

A
  • optic neuritis
  • brainstem symptoms
  • spinal cord symptoms
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10
Q

what is optic neuritis?

A
  • inflammation of optic nerve
  • results in pain on eye movement, blurring of vision, red colour saturation
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11
Q

Uhthoff’s phenomenon

A
  • transient worsening of neurological symptoms related to a demyelinating disorder such as multiple sclerosis when the body becomes overheated in hot weather, exercise, fever, saunas, or hot tubs
  • irritates scar tissue in optic nerve

occurs in pts who have previously had optic neuritis

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12
Q

what brainstem symptoms can be associated with MS?

A
  • vertigo
  • slurred speech
  • ataxia
  • incoordination
  • double vision
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13
Q

what spinal cord symptoms can be associated with MS?

A
  • sensory - Lhermitte’s phenomenon
  • motor - upper and/or lower limb weakness
  • bladder, bowel, sexual dysfunction
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14
Q

what is Lhermitte’s phenomenon?

A

flexion of the neck causes “electric shock” sensation down neck + parastesia

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15
Q

what is radiologically isolated syndrome?

A
  • pts have typical MS signs on scans, eg. demyelination and lesions
  • but do not have clinical symptoms
  • therefore, no MS diagnossi
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16
Q

what is clinically isolated syndrome?

A
  • pts have damage seen on scans that is typical of MS
  • also have a one off occasion of MS symptoms
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17
Q

draw a diagram showing the difference between upper and motor neurone signs for:
* muscle bulk
* fasciculations
* tone
* power
* reflexes
* clonus
* babinski’s sign

A
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18
Q

what are fasciculations?

A

muscle twitching that occurs when a single peripheral nerve is overactive

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19
Q

what would be a positive clonus sign?

A
  • examiner feels and sees the oscillations of the foor against pressure
  • 3 or more is abnormal
20
Q

what is a positive babinski sign?

A

flexion of big toe and fanning of other toes

21
Q

in what pt group is a positive babinski sign normal?

A
  • newborns and infants
  • should be absent after 24 months
22
Q

MS characteristically has which of the following - UMN signs or LMN signs?

A

upper motor neuron

23
Q

what are 3 main investigations for MS diagnosis?

A
  • MRI
  • lumbar puncture
  • evoked potentials (usually visual)
24
Q

what are 5 common sites of demyelination is MS?

A
  • corpus callosum
  • optic nerve
  • cerebellum
  • brainstem
  • spinal cord
25
Q

what are oligoclonal bands?

A

immunoglobulins

26
Q

what does the presence of oligoclonal band in CSF indicate?

A
  • inflammation of CNS
  • can indicate MS diagnosis
27
Q

what findings in CSF may indicate MS?

A

oligoclonal bands type 2

28
Q

what are visual evoked potentials?

A
  • tests optic nerve pathway from eyes to visual cortex
  • electrical signals recorded through the scalp
29
Q

what finding on a visual evoked potential may indicate MS?

A
  • delayed VEP
  • demyelination in anterior visual pathways
30
Q

what two evoked potentials can be used in MS diagnosis?

A
  • visual evoked potentials
  • somatosensory evoked potentials
31
Q

what do somatosensory evoked potentials assess?

A
  • posterior column of spinal cord, brainstem and cerebral cortex
32
Q

what are the main criteria for MS diagnosis?

A

two different relapses (space) at two different times

33
Q

dissemination in space - what does this mean in MS diagnosis?

A

must be a development of lesions in two or more distinct anatomical locations in CNS
* brainstem
* juxtacortical
* periventricular
* spinal cord

34
Q

dissemination in time - what does this mean in MS diagnosis?

A

development or appearance of new CNS lesions over time
OR
positive oligoclonal bands

35
Q

what factors can indicate better prognosis in early MS?

A
  • caucasion
  • female
  • monofocal onset
  • onset with optic neuritis or isolated symptoms
  • low relapse in first 5 years
  • long interval to second relapse
36
Q

if MS pts have onset symptoms with motor, cerebellar or bladder or bowel symptoms, would this indicate a better or poorer prognosis?

A

poorer

37
Q

what is the inheritance risk of MS for someone with a first degree relative?

A

1:25

38
Q

the majority of MS pts have what type of MS?

A

relapsing-remitting (85-90%)

39
Q

what is relapsing-remitting MS?

A
  • attacks with complete or partial recovery (still neuronal damage)
  • no progression between attacks (remission)
40
Q

what is secondary progressive MS?

A
  • initial relapsing-remitting course followed by progression (without active disease but due to neuronal degeneration)
  • with or without attacks
41
Q

what is primary progressive MS?

A
  • steady progression from onset
  • no attacks or remission
42
Q

what is progressing-relapsing MS?

A

progression from onset with attacks

43
Q

are pts always aware of MS relapses?

A

no - can only be aware 10-15 years later when neuronal degeneration is significant

44
Q

how are MS relapses treated?

A
  • high doses of corticosteroids (orally or IV)
  • reduce inflammatory activity and stabilise blood brain barrier
45
Q

what is natalizumab or tysabri?

A
  • disease modigying therapy (DMT)
  • binds to T cells and stops them degrading myelin sheath
46
Q

when can pts take tysabri for MS?

A
  • relapsing MS
  • at least two relapses in last year
  • MRI shows new signs that MS is active

Med School Yr 2 (96 decks)

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