MS

Question 0

Who gets it?

Answer 0

Most commonly affects 30 year old women, 10% get it befor 18 years of age.

Question 1

What is MS?

Answer 1

Inflammatory disease cause damage to myelin.

Question 2

S + S?

Answer 2

Depends on locations affected

Eye problems

• optic neuritis (pain)
• afferent pupillary defect present
• Diplopia

Motor weakness
- spastic weakness

Sensory

• loss or tingling
• Trigeminal neuralgia

sexual dysfunction
Dysphagia
Depression

Question 3

Signs?

Answer 3

Lhermettes sign

• flexion of neck causes electric shocks down spine indicating cervical lesion
• uhthoffs phenomenon: worsening of symptoms in heat

Question 4

Ix?

Answer 4

LAB
CBE EUC LFT 
Lumbar puncture and CSF microscopy 
- oligoclonal bands 
- mononuclear cell pleiocytosis
- increased IgG

RAD
- MRI with gadolinium contest. Increased enhanced lesions suggest acute plaque. Dawson’s fingers: peri ventricular lesions extending superiorly into corpus collosum

Question 5

Diagnosis?

Answer 5

Mcdonalds criteria: dissemination in time and space is key.

Question 6

Rx?

Answer 6

No option for re-myelinination.

Acute attacks

• IV methyl prednisolone
• IV Ig

Disease modifying

• IFN-B delays progression of 1st demyelination event to MS
• immunomodulatoes

Adjuncts

• depression: SSRI
• spasticity: physiotherapy, stretching, baclofen

Question 7

What are the types of disease course for MS?

Answer 7

Relapsing/remitting
Secondary progressing
Primary progressing progressive

Question 8

What percentages of patients presenting with an MS like episode and consistent MRI lesions go on to develop MS?

Answer 8

90%