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neuro > A23. Multiple sclerosis > Flashcards

A23. Multiple sclerosis Flashcards

1
Q

Multiple sclerosis Definition

A

Chronic, progressive, multifocal, autoimmune inflammatory disease of the CNS.

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2
Q

Multiple sclerosis is more common in which gender

A

Women:men = 2:1

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3
Q

age onset of Multiple sclerosis

A

Disease of young adult, starts in 30-40s

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4
Q

in n which region is Multiple sclerosis more frequent

A

More frequent in the northern hemisphere

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5
Q

etiology of Multiple sclerosis

A

A. Genetic susceptibility: HLA, some increased risk in relatives
B. Environmental factors: Viruses, geographic latitude (more towards the poles), vitamin D

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6
Q

Environmental factors that could cause Multiple sclerosis

A
  • Viruses,
  • geographic latitude (more towards the poles),
  • vitamin D
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7
Q

pathology Multiple sclerosis

A
  • T-cells are activated in the periphery, then cross-react with parts of myelin in the CNS →
    Demyelination and secondary axon degeneration.
    The demyelinated regions are called plaques.
    ● Active plaques are characterized by blood-brain barrier dysfunction, perivascular infiltration of
    lymphocytes and plasma cells and segmental demyelination.
    ● In chronic plaques, scar tissue is formed (sclerosis) due to astrocyte proliferation
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8
Q

Active plaques in multiple sclerosis are characterized by

A
  • blood-brain barrier dysfunction,
  • perivascular infiltration of lymphocytes and plasma cells
  • and segmental demyelination.
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9
Q

what happens In chronic plaques that occur in multiple sclerosis

A

scar tissue is formed (sclerosis) due to astrocyte proliferation

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10
Q

what is meant by plaques in multiple sclerosis

A

The demyelinated regions are called plaques
(T-cells are activated in the periphery, then cross-react with parts of myelin in the CNS →
Demyelination and secondary axon degeneration)

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11
Q

Pathological types of multiple sclerosis

A

a. T-cell and macrophage mediated inflammation
b. B-cell and complement mediated inflammation
c. Oligodendrocyte destruction, axonal lesion
d. Primary oligodendrocyte dystrophy

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12
Q

Main points about Multiple sclerosis

A
  • Demyelination
  • Inflammation
  • Secondary axonal damage
  • Inflammatory processes → Relapses
  • Secondary axonal damage → Brain atrophy → Deficits (delayed manifestation)
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13
Q

Secondary axonal damage in multiple sclerosis leads to

A

→ Brain atrophy → Deficits (delayed manifestation)

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14
Q

Possible symptoms of Multiple sclerosis

A
  • Optic neuritis - Blurry vision, pain on movement, often first sign
  • Sensory - Paresthesias, numbness, tingling, always distribution specific for central cause
  • Motor symptoms - Paraparesis, hemiparesis, monoparesis, tetraparesis
  • Brainstem symptoms - Gaze palsy, internuclear ophthalmoplegia (INO), trigeminal pain
  • Cerebellar symptoms - Limb/trunk ataxia, dysarthria, nystagmus, tremor, coordination/balance
    problem
  • Autonomic symptoms - Urge incontinence (detrusor hyperactivity), detrusor-sphincter dyssynergia
  • Cognitive symptoms, subcortical dementia
  • Paroxysmal symptoms (may occur several hundred times a day, short duration) - Lhermitte’s
    sign, trigeminal neuralgia, dystonia, hemiataxia
  • Aspecific symptoms - Fatigue, depression
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15
Q

which tracts are involved in multiple sclerosis?
which are more affected?

A

May involve all tracts of CNS, but longer tracts are more affected.

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16
Q

which symptom often manifests first in multiple sclerosis

A

Optic neuritis -
* Blurry vision
* pain on movement
often first sign

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17
Q

Sensory symptoms in multiple sclerosis

A
  • Paresthesias,
  • numbness,
  • tingling,
  • always distribution specific for central cause
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18
Q

Motor symptoms in multiple sclerosis

A
  • Paraparesis,
  • hemiparesis,
  • monoparesis,
  • tetraparesis
19
Q

Brainstem symptoms -in multiple sclerosis

A
  • Gaze palsy,
  • internuclear ophthalmoplegia (INO),
  • trigeminal pain
20
Q

Cerebellar symptoms -in multiple sclerosis

A
  • Limb/trunk ataxia,
  • dysarthria,
  • nystagmus,
  • tremor,
  • coordination/balance problem
21
Q

Autonomic symptoms - in multiple sclerosis

A
  • Urge incontinence (detrusor hyperactivity),
  • detrusor-sphincter dyssynergia
22
Q

Paroxysmal symptoms in multiple sclerosis

A

(may occur several hundred times a day, short duration) -
* Lhermitte’s sign,
* trigeminal neuralgia,
* dystonia,
* hemiataxia

23
Q

Lhermitte’s sign

A

(Barber chair phenomenon)
* is a transient sensation of an electric shock that extends down the spine and extremities
* upon flexion and/or movement of the neck.

24
Q

Diagnostic criteria of multiple sclerosis

A

McDonald criteria (2017) →
* Prove that inflammation is chronic (dissemination in time) and
* widespread (dissemination in space)

25
Q

McDonald criteria (2017)

A
  • for multiple sclerosis
26
Q

In case of zero attacks and lesions what additional criteria is needed for diagnosis of MS based on McDonald criteria

A
  • One year of disease progression (retrospective/prospective)
  • and at least 2 out of 3 criteria:
    *dissemination in space in the brain
    *dissemination in space in the spinal cord based on 2 or more T2 lesions
    *Positive CSF
27
Q

In case of 1 attack, 1 lesion what additional criteria is need for diagnosis of MS

A

disseminatiton in space and time
or
await for further clinical attack implicating a different CNS site

28
Q

In case of 1 attack, 2 lesions what additional criteria is needed for diagnosis of MS

A

Dissemination in time on MRI
or
await for further clinical attack implicating a different CNS site

29
Q

In case of 2 or more attacks, and 1 lesion what additional criteria is needed for diagnosis of MS

A

Dissemination in space on MRI
OR
await for further clinical attack implicating a different CNS site

30
Q

In case of 2 or more attacks, and 2 or more lesions what additional criteria is needed for diagnosis of MS

A

None
Clinical evidence alone will suffice

31
Q

First choice of diagnostic tool in Multiple sclerosis

A

MRI

32
Q

Diagnostic tools in Multiple sclerosis

A
  • MRI (first choice)
  • CSF examination
  • Evoked potentials
  • Serology (differential)
33
Q

what is seen on MRI in multiple sclerosis

A
  • typical distribution of demyelinated plaques around:
    *ventricles
    *juxtacortically
    *corpus callosum
    *brain,
    *spinal cord
34
Q

what is MRI used for in multiple sclerosis

A
  • diagnosis
  • follow up
35
Q

CSF examinations in multiple sclerosis

A
  • normal routine values,
  • OCBs (oligoclonal bands)
  • Not needed for diagnosis, but may support it. Characteristic to see elevated IgG index or presence of oligoclonal gammopathy (OGP).
36
Q

Evoked potentials use in diagnosis of MS

A
  • VEP(Visual Evoked Potential) to investigate visual tract,
  • MEP(Motor evoked potentials )
  • SEP( somatosensory evoked potention test)
37
Q

SEP Somatosensory evoked potential

A
  • The electrical response of the brain, as measured by electroencephalography, in response to electrical stimulation of superficial nerves (e.g., tibial nerve).
  • studies the relay of body sensations to your brain and how the brain receives those sensations.
38
Q

Motor evoked potentials (MEPs)

A
  • are electrical signals recorded from muscle tissue in response to stimulation of the motor cortex.
  • The stimulation may be magnetic or electrical
  • applied directly to the motor cortex or
  • applied transcranially through the skull
39
Q

Stimulus of Visual evoked potential (VEP) and in which disorders is it indicated

A

Light impulse
Checkered patterns
* Demyelinating disorders (e.g., optic neuritis in the case of multiple sclerosis)

40
Q

Somatosensory evoked potential (SEP) is indicated in

A

Demyelinating disorders (e.g., multiple sclerosis) and axonal damage

41
Q

Motor evoked potential (MEP) is indicated in

A
  • Damage to the motor cortex and other motor neurons (e.g., amyotrophic lateral sclerosis)
  • Demyelinating disorders (e.g., multiple sclerosis) and axonal damage
42
Q

Serology in MS

A

(differential) -
* Borreliosis,
* Treponema,
* anti-AQP4 (very specific for Devic’s disease)

43
Q

Devic disease or neuromyelitis optica) is also knows as

A
  • Neuromyelitis optica spectrum disorders (NMOSD)
  • previously known as Devic disease or neuromyelitis optica) is also knows as
44
Q

definition of Devic disease

A

immune-mediated, chronic inflammatory disorders of the CNS that primarily affect the optic nerve and spinal cord
Closely resembles the clinical appearance of MS

neuro (32 decks)

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