MS Flashcards
What is MS?
a chronic, cell-mediated autoimmune disorder characterised by demyelination in the central nervous system
Who gets MS?
3 x more common in women
people aged 20-40 yrs
ppl living in higher latitudes
- typical pt: white woman in 20s
Outline the pathophysiology of MS
Immune mediated (cell infiltration + inflammation) demyelination of CNS neurones > nerve cell degeneration.
Electrical signal travel is disrupted > symptoms of MS
Early stages neurones re-myelinate > clinical remission.
Recurrent episodes > neuronal damage > permanent clinical deficit.
What are the key characteristic features of MS in terms of when symptoms appear?
- Dissemination is space (DIS)
- Dissemination in time (DIT)
- episodic
- relapsing and remitting course
What cells make myelin in the CNS
Myelin is made my oligodendrocytes in the central nervous system.
Schwann = peripheral
Causes of MS
Genetic / Autoimmune / Environment factors
Multiple gene
EBV
Low vitamin D
Smoking
Obesity
What are some common signs in initial presentation of MS (lecture BB)
Optic neuritis
Ataxia
Dizziness (vertigo)
Weakness
Diplopia
Bladder / bowel dysfunction
Neuropathic pain (e.g. trigeminal neuralgia)
sensory loss / disturbance in face or limbs
Other common:
Fatigue
Spasticity
sexual dysfunction
cognitive impairment (later)
What are the names of subtypes of MS?
Relapsing - remitting disease
Secondary progressive disease
Primary progressive disease
What is relapsing-remitting disease in MS?
Most common - 85% pts
acute attacks of disease ( 1-2 months) followed by remission.
further classified by:
- Active- new symptoms/lesions on MRI
-Worsening - disability increasing over time
What is secondary - progressive disease in MS?
Pts who started with relapsing- remitting but have now deteriorated.(65% of R-R get w/in 15 yrs)
Pts have neurological signs and symptoms which are more permanent
Gait and bladder disorders common
What is Primary progressive disease in MS?
10% of pts
Worsening and deterioration from onset on MS
Older pts more likely
How is a diagnosis made in MS?
- multiple lesions of the CNS occurring both in time (recurrent episodes) and space (different sites).
-consultant neurologist and be based upon the 2010 McDonald criteria
What is the MacDonald criteria?
For diagnosis of MS
What is the MacDonald criteria?
For diagnosis of MS (workbook)
- Lesions consistent with an inflammatory process
- No alternative diagnosis
- Multiple lesions in time and space (Relapsing remitting MS)
- Progressive neurological deterioration for 1 year (Primary progressive MS)
How would you diagnose a relapse of MS?
- Develops new symptoms
- Has rapid worsening of existing symptoms
- Symptoms last for more than 24 hours in the absence of infection or other cause after a stable period of one month or
more
What investigations can be used to support a diagnosis of MS?
MRI of brain / spinal cord for demyelination plaques - see high T2-signal intensity lesions on MRI
Analysis of CSF - would see oligocolonal bands on CSF electrophoresis
What type of MRI would you order for MS investigation?
T2 weighted shows high signal (bright) lesions. Varying degrees of contrast show active / recent demyelination.
Also use MRI flair to show lesions (bright)
What findings do you see on MRI with a patient who has MS?
- High signal T2 lesions
- Periventricular plaques
- Dawson fingers (FLAIR) - hyperintense lesions perpendicular (sticking up like mohawk) from corpus callosum.
What does analysis of CSF show in a patient with MS?
Immunoelectrophoresis is performed showing oligoclonal bands of IgG
increased intrathecal IgG synthesis
What visual features do you get with MS?
optic neuritis: common presenting feature
optic atrophy
Uhthoff’s phenomenon: worsening of vision following rise in body temperature e.g. bath
internuclear ophthalmoplegia
What sensory features do you get with MS?
pins/needles
numbness
trigeminal neuralgia
Lhermitte’s syndrome: paraesthesiae in limbs on neck flexion
What motor features do you get with MS?
spastic weakness: most commonly in legs
What cerebellar features do you get with MS?
Ataxia: depending on where the plaque is:
-Sensory (proprioception, Romberg)
- Cerebellar (co-ordinating movement)
Tremor
What are some ‘other’ features of MS ? i.e. not motor, sensory, visual or cerebellar
urinary incontinence
sexual dysfunction
intellectual deterioration
