MS Flashcards
What is MS?
Chronic condition involving autoimmune demyelination of neurones in the CNS
Pathophysiology of MS?
Activation of immune cells against the myelin (oligodendrocytes) covering neurones in the CNS
Myelin is provided by Schwann cells in the PNS and Oligodendrocytes in the CNS
In early disease, remyelination can occur
Characteristic feature of MS?
Lesions vary in location over time
DISSEMINATED IN SPACE AND TIME
Causes of demyelination?
Unsure but linked to:
Multiple genes
EBV
Low vit D
Smoking
Obesity
How do symptoms present?
Symptoms usually progress over 24 hours. At first presentation, symptoms last days-weeks them improve.
5 symptom categories?
Optic neuritis
Eye movement abnormalities
Focal weakness
Focal sensory symptoms
Ataxia
What is Optic neuritis?
Features of it?
Caused by what in MS?
Other causes of it?
How is it treated?
Most common MS presentation.
Loss of vision in one eye.
Other features are pain on movement, impaired colour vision, relative afferent pupillary defect
In MS it is caused by demyelination (and inflammation) of the optic nerve.
It can also be caused by measles, mumps, lyme disease, diabetes, sarcoidosis, SLE, syphilis
Treated with steroids, recover in 2-6 weeks
Eye movement abnormalities- 2 phrases?
Which nerve is affected?
Sixth cranial nerve (abducens) palsy= double vision
Internuclear ophthalmoplegia- internuclear means the nerve fibres connecting the 3rd,4th and 6th cranial nuclei (movement is not coordinated)
Conjugate lateral gaze disorder- affected eye doesn’t move laterally- if L eye affected, when looking to the L the R eye will adduct and the L eye will remain in the middle
Focal weakness (includes 4 things)?
Bells palsy- weak one side of face
Horners syndrome- miosis, anhidrosis, ptosis
Limb paralysis
Incontinence
Focal sensory symptoms (4 things?)
Trigeminal neuralgia- sudden pain in face
Paraesthesia (pins and needles)
Numbness
Lhermitte’s sign- electric shock down spine into limbs when flexing neck= demyelinated dorsal column in C spine
Ataxia: what is it and what are the 2 types?
Ataxia is problem with coordinated movement
Sensory ataxia= loss of proprioception. You need 2 out of 3 of sight, vestibular and proprioception for sensory balance. Positive Romberg’s test= sensory ataxia (because vision is removed)
Cerebellar ataxia= problem with cerebellum coordinating movement (cerebellar lesion)
Disease patterns of MS
Clinically isolated
Relapsing-remitting
Secondary progressive
Primary progressive
How is MS diagnosed?
Which investigations can help diagnose?
Clinical picture of lesions changing location
MRI scans to see lesions
LP to detect “oligoclonal bands” in the CSF but not present in the blood.
Management of MS?
MDT
Disease-modifying drugs
Relapses are treated with methylprednisolone (steroids)
How to treat symptoms?
Exercise
Neuropathic pain= gabapentin and amitryptiline (TCA)
Depression= SSRIs
Urge incontinence= anti-cholinergics (oxybutynin) (because bladder contraction is parasympathetic)
Spactiity= baclofen, gabapentin, physio
