Demyelinating conditions Flashcards
What is multiple sclerosis?
A demyelinating disease affecting the CNS, dispersing plaques throughout the brain and spinal cord
What is the ratio of females:males affected by MS?
3:1
At what age does MS usually present?
Can present at any age, but usually 30s & 40s
What are the clinical signs of MS?
- pyramidal dysfunction
- optic neuritis
- sensory symptoms
- lower urinary tract dysfunction
- cerebellar & brain stem features
- cognitive impairment
What symptoms and signs would the pyramidal dysfunction seen in MS cause?
Increased tone, spasticity and weakness of the extensors of upper limbs and flexors of lower limbs
How does MS affect the eyes and what would be seen on examination?
Causes optic neuritis resulting in painful visual loss over the course of 1-2 weeks
On examination - swollen optic disc and RAPD
What sensory symptoms does MS cause?
- pain
- paraesthesia
- numbness
- dorsal column loss: vibration and proprioception
- trigeminal neuralgia
What cerebellar symptoms and signs are associated with MS?
- ataxia
- intention Tremor
- nystagmus
- past pointing
- pendular reflexes
- dysdiadokinesis
- dysarthria
What symptoms would this MS brainstem lesion produce?
Diplopia (R VI palsy)
Facial weakness (R VII palsy)
What is opthalmoplegia?
Weakness or paralysis of the eye muscles
What is internuclear opthalmoplegia?
A disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction
Where is the injury that would cause this clinical sign?
The right medial longitudinal fasiculus
What symptoms and signs does IN opthalmoplegia cause?
- distortion of binocular vision
- failure of adduction, causing diplopia
- nystagmus in abducting eye
What are the four potential clinical courses of MS?
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
What are some differential diagnosis that present similarly to MS?
- vasculitis
- granulomatous disorder
- vascular disease
- structural lesion
- infection
- metabolic disorder
What would show positive in a CSF sample with MS?
Oligoclonal bands - show positive in 90% + of cases
What is clinically isolated syndrome?
A term that describes a first and single neurologic episode of inflammation or demyelination in the CNS lasting at least 24 hours
What is the most common type of MS?
Relapsing remitting MS
What is relapsing remitting MS?
Distinct attacks of symptoms which fade away almost entirely or completely
What proportion of relapsing remitting MS goes on to become secondary progressive MS?
60%
Which patients tend to be affected by primary progressive MS?
Older males
What is primary progressive MS?
MS that is characterized by steady worsening of neurologic functioning, without any distinct relapses or periods of remission
What is the least common form of MS?
Progressive-relapsing MS
What is progressive-relapsing MS?
MS that progressively reduces neurological ability but also has acute attacks
