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Neurology > Demyelinating conditions > Flashcards

Demyelinating conditions Flashcards

1
Q

What is multiple sclerosis?

A

A demyelinating disease affecting the CNS, dispersing plaques throughout the brain and spinal cord

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2
Q

What is the ratio of females:males affected by MS?

A

3:1

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3
Q

At what age does MS usually present?

A

Can present at any age, but usually 30s & 40s

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4
Q

What are the clinical signs of MS?

A
  • pyramidal dysfunction
  • optic neuritis
  • sensory symptoms
  • lower urinary tract dysfunction
  • cerebellar & brain stem features
  • cognitive impairment
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5
Q

What symptoms and signs would the pyramidal dysfunction seen in MS cause?

A

Increased tone, spasticity and weakness of the extensors of upper limbs and flexors of lower limbs

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6
Q

How does MS affect the eyes and what would be seen on examination?

A

Causes optic neuritis resulting in painful visual loss over the course of 1-2 weeks

On examination - swollen optic disc and RAPD

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7
Q

What sensory symptoms does MS cause?

A
  • pain
  • paraesthesia
  • numbness
  • dorsal column loss: vibration and proprioception
  • trigeminal neuralgia
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8
Q

What cerebellar symptoms and signs are associated with MS?

A
  • ataxia
  • intention Tremor
  • nystagmus
  • past pointing
  • pendular reflexes
  • dysdiadokinesis
  • dysarthria
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9
Q

What symptoms would this MS brainstem lesion produce?

A

Diplopia (R VI palsy)

Facial weakness (R VII palsy)

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10
Q

What is opthalmoplegia?

A

Weakness or paralysis of the eye muscles

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11
Q

What is internuclear opthalmoplegia?

A

A disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction

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12
Q

Where is the injury that would cause this clinical sign?

A

The right medial longitudinal fasiculus

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13
Q

What symptoms and signs does IN opthalmoplegia cause?

A
  • distortion of binocular vision
  • failure of adduction, causing diplopia
  • nystagmus in abducting eye
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14
Q

What are the four potential clinical courses of MS?

A

Relapsing remitting

Secondary progressive

Progressive relapsing

Primary progressive

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15
Q

What are some differential diagnosis that present similarly to MS?

A
  • vasculitis
  • granulomatous disorder
  • vascular disease
  • structural lesion
  • infection
  • metabolic disorder
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16
Q

What would show positive in a CSF sample with MS?

A

Oligoclonal bands - show positive in 90% + of cases

17
Q

What is clinically isolated syndrome?

A

A term that describes a first and single neurologic episode of inflammation or demyelination in the CNS lasting at least 24 hours

18
Q

What is the most common type of MS?

A

Relapsing remitting MS

19
Q

What is relapsing remitting MS?

A

Distinct attacks of symptoms which fade away almost entirely or completely

20
Q

What proportion of relapsing remitting MS goes on to become secondary progressive MS?

A

60%

21
Q

Which patients tend to be affected by primary progressive MS?

A

Older males

22
Q

What is primary progressive MS?

A

MS that is characterized by steady worsening of neurologic functioning, without any distinct relapses or periods of remission

23
Q

What is the least common form of MS?

A

Progressive-relapsing MS

24
Q

What is progressive-relapsing MS?

A

MS that progressively reduces neurological ability but also has acute attacks

25
Q

How is MS diagnosed?

A

Clinical

Bloods

MRI - plaques disseminated in time

CSF - oligoclonal bands

26
Q

How is an acute exacerbation of MS treated?

A

Mild - supportive

Moderate - oral steroids

Severe - IV steroids/admission

27
Q

What treatment is avaliable for spasticity associated with MS?

A
  • education
  • physiotherapy
  • oral baclofen or tizanidine
  • I.M. Botulinum toxin
  • nerve blocks
  • intrathecal baclofen/phenol
  • surgery
28
Q

What treatment is avaliable for sensory symptoms associated with MS?

A
  • gabapentin (anti convulsant)
  • amitryptilline
  • tens machine
  • acupuncture
  • lignocaine infusion
29
Q

What treatment is avaliable for the lower urinary tract dysfunction associated with MS?

A
  • bladder drill
  • anticholinergics
  • desmopressin
  • catheter
30
Q

What are the first line disease modifying agents used for MS?

A
  • Interferon Beta: Avonex, Rebif, Betaseron, Extavia
  • Glitiramer Acetate (Copaxone)
  • Tecfedira
31
Q

What are the beneficial properties of interferon beta and copaxone as disease modifying treatment for MS?

A
  • injectable
  • decrease relapse rate by 1/3
  • decrease severity of relapses by 50%
  • positive effect on disability
32
Q

What is the first line indication in relapsing remitting MS?

A

Tecfidera

33
Q

Why are the second line (tysabri, fingolimod) and third line (mitoxantrone) therapies for MS not used despite being more effective?

A

Dangerous - can cause death

Neurology (17 decks)

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