Clinical classification of MS Flashcards
What % are RR and what % are PP or PR
85% RR
15% PP OR PR
What is the first attack in RR MS?
Clinically isolated syndrome -
Onset to peak worsening- days
Recover - may be complete or incomplete
3 MAIN initial symptoms
- Sensory MOSTLY LIMB not face (30-43%)
- Optic neuritis (14-24%)
- Weakness - acute (9-40%)
If you have a CIS in MS
MAJORITY 50-70% of patients will have multiple lesions on MRI
Over time… what happens to MRI burden
Increases - total number of accumulated lesions goes up
Over time what happens to MRI activity or the number of attacks?
DECREASES - more attacks earlier
- permanent disability also goes up
What does a new relapse or new lesion mean?
Dissemination in time
Multiple in MS refers to
Multiple in SPACE AND TIME
Common symptoms in MS
- easy fatiguability
- Impaired vision
- brainstem dysfunction
- cerebellar problem
- sensory issues
- Motor - spasticity
- retention/incontinnence urinary
Common Physical FINDINGS
1. intelligence not affected - may have memory loss - attention loss - not linked to disability 2 - Optic nerve atrophy, scotoma, RAPD 3 - impaired smooth pursuit, INO, 4- Dysarthria 5 - emotional lability 6- exaggerated gag and jaw reflex 7- UMN signs 8 - Decreased vibration/prop/two point discrimination 9 - cerebellar
Diagnosis of MS IS PRIMARILY
A clinical diagnosis
which is more sensitive in MS- cranial or Spinal MRI
CRANIAL MRI is more sensitive
OVER 50 - spinal MRI is more specific
Majority of MS lesions are
Clinically silent
spiNAL CORD MRI is abnormal in
75% of cases
In patients over 50
a spinal mri IS valuable! and more specific
Differential DX for MS
- Sarcoidosis
- Vasculitis
- Lupus
- ADEM
- HIV
When do you question a diagnosis of MS
- 60
- all symptoms leading to single site
- lack of optic nerve, oculomotor, sensory or bladder involvement after many years
- absence of remission
- CSF/MRI persistently normal
Unfavorable prognosis
- high relapse
- short interval to second attack
- lack of full recovery
- older age at onset
- male gender
- high burden on first MRI
- early cerebellar involvement
- motor onset
Corticosteroids ARE
NOT EFFECTIVE IN SLOWING OR PREVENTING PRGORESSION
