MS Flashcards
What is MS?
Chronic inflammatory disease of the CNS characterised by relapsing remitting, or progressive neurologic symptoms due to inflammation, demyelination and axonal degeneration.
What is the aetiology of MS?
- Genetic: polygenetic, 30% concordance for monozygotic twins, 2-4% offspring risk
- Environmental: more common in regions further from equator
- Viral infection: e.g. EBV
What are the symptoms of MS?
Depends on the position of plaques. Common Sx:
- numbness
- visual disturbance (optic neuritis)
- weakness
- spasticity
- diplopia (INO)
- impaired gait
- vertigo
- bladder dysfunction
What Ix in MS?
- MRI: demyelinating plaques seen as hyper intense lesions on T2; active lesions enhance with gadolinium
- CSF: oligoclonal bands in 90%, increased IgG concentration
- Evoked potentials
Rx of MS?
ACUTE: methylprednisolone 1000mg IV OD x3-7/7 DISEASE MODIFYING: IFNb SYMPTOMATIC: -Muscle spasm: baclofen -Tremor: clonazepam -Pain: gabapentin -Urinary incontinence: anticholinergics (e.g oxybutynin) -Antidepressants -Constipation: high fibre intake -Sexual dysfunction: sildenfail
MS prognosis?
Increased risk of suicide; mean prognosis 25 - 35 years.
What is internuclear opthalmoplegia?
Lesion affects left medial longitudinal fascicles (MLF) and prevents adduction of the ipsilateral eye during conjugate gaze; convergence usually normal.
Epidemiology of MS?
- Onset 17-35y
- -> 3F:1M
- Onset older with 1F:1M
What is Lhermitte’s sign?
Flexion of neck causes electric shock sensation down back into limbs indicating cervical cord lesion
What is Uhthoff’s phenomenon?
Worsening of symptoms (classically optic neuritis) with heat
Typical locations of MS lesions?
- Periventricular
- Corpus callosum
- Cerebellar peduncles
- Brainstem
- Juxta cortical regions
- Dorsolateral spinal cord
