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NEURO > MS > Flashcards

MS Flashcards

1
Q

what is multiple sclerosis

A

demyelinating disease in which the myelin sheaths of nerve cells in the brain and spinal cord (CNS) are damaged

inflammatory

white matter affected

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2
Q

what kind of disturbances does MS cause

A

focal disturbance of function-relapse

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3
Q

what is the general course of MS

A

relapsing remitting course

most patients develop progressive disability

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4
Q

what determines what disability is gained from MS

A

location of the damage

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5
Q

what is demyelination

A

an autoimmune process - caused by activated T cells crossing the blood brain barrier

acute inflammation of the myelin sheath

results in loss of function

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6
Q

what is post inflammatory gliosis and what can it cause

A

non-specific reactive change of glial cells in response to damage - effectively like scarring in the CNS

can cause functional deficits

seen as lesions or plaques on MRI

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7
Q

what can increase your risk of MS

A

having other auto-immune diseases

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8
Q

what is an important part of disease progression

A

axonal loss

probably present from disease onset

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9
Q

what is axonal loss seen as on MRI

A

seen as black holes

later seen as cerebral atrophy

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10
Q

what can lead to MS

A

complex genetic inheritance
autoimmune diseases

female:male 2-3:1

more common in temperate climate

?virus - Epstein Barr virus
?vitamin D exposure

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11
Q

how does MS usually present

A

80% cases present with a relapse

  • gradual onset over days
  • stabilises days to weeks
  • gradual resolution to complete or partial recovery
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12
Q

what are some symptoms of a relapse

A

Optic neuritis
Sensory symptoms
Limb weakness
Brainstem Diplopia/Vertigo/Ataxia-
Spinal cord-bilateral symptoms and signs +/- bladder

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13
Q

what is optic neuritis

A

inflammation of the optic nerve

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14
Q

what are the symptoms of optic neuritis

A

Subacute visual loss
Pain on moving eye
Colour vision disturbed

Usually resolves over weeks

Initial swelling optic disc
Optic atrophy seen later

Relative afferent pupillary defect - ie pupil dilates when light shone onto it

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15
Q

aside from MS what are some other causes of optic neuritis

A 
Neuromyelitis optica
Sarcoidosis
(Ischaemic optic neuropathy)
Toxic/ drugs/ B12 deficiency
Wegeners granulomatosis
(Local compression)
Lebers hereditary optic neuropathy
Infection-borrelia
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16
Q

how does a brainstem relapse present

A

cranial nerve involvement
weakness in the extraocular muscles

cerebellum - vertigo, nystagmus, ataxia

UMN changes in limbs

sensory involvement

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17
Q

what are the types of myelitis in MS

A

partial - incomplete

transverse - complete

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18
Q

how does myelitis present in MS

A

band of hyperaesthesia at sensory level

weakness/UMN changes below level

bladder and bowel involvement

may be painful

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19
Q

aside from MS what are the causes of myelitis

A

inflammation

  • devics (myelitics + optic neuritis)
  • SLE (systemic lupus erythmatosis)
  • sarcoidosis (abnormal collections of inflammatory cells that form lumps known as granulomas

infection
- HIV, HTLV, HSV, TB, borrelia, mycoplasma

tumour

paraneoplastic process

stroke

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20
Q

what are isolated episodes of demyelination

A

when someone presents with an episode but then have no further episodes

named as such retrospectively

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21
Q

when can further relapses occur

A

within months or years of the first relapse

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22
Q

how can further relapses present

A

variable to site and severity

optic neuritis 
sensory
limb weakness
diplopia
vertigo
ataxia
sphincter disturbances
23
Q

what is the progressive phase of relapses

A

accumulation of signs and symptoms

24
Q

what are progressive phase symptoms

A 
Fatigue, temperature sensitivity
Sensory
Stiffness or spasms
Balance, slurred speech
Swallowing
Bladder & bowel
Diplopia/ oscillopsia/ visual loss
Cognitive-dementia/ emotional lability
25
what can be seen on examination of MS
``` Afferent pupillary defect Nystagmus or abnormal eye movements Cerebellar signs Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor ```
26
what are the 2 main ways to diagnose MS
evidence of demyelination separated in time and space clinical - Posers criteria MRI - Macdonald criteria
27
what is the Macdonald criteria for diagnosing MS
for every 10 brain lesions the patient experiences 1 relapse
28
how do you differentiate between T1 and T2 MRI
T1 - lipid light, fluid dark | T2 - lipid light, fluid light
29
what other investigations can be used to help aid diagnosis of MS
lumbar puncture - oligoclonal bands present in CSF but not serum visual/somatosensory evoked response bloods - excuse other inflammatory conditions chest x-ray - exclude sarcoidosis
30
what are the differential diagnosis for MS
Acute Disseminated Encephalomyelitis (ADEM) Other Auto-immune conditions eg SLE Sarcoidosis Vasculitis Infection eg Lyme disease, HTLV-1 Adrenoleucodystrophy etc etc
31
what are the different types of MS
relapsing remitting primary progressive secondary progressive sensory malignant
32
what is the course of MS in relapsing remitting
``` initial episode second episode larger third episode smaller fourth episode even smaller etc ```
33
what is the course of MS in secondary progressive MS
initial episode second episode smaller third episode starts very small but progressively worsens - doesn't go away
34
what is the course of sensory MS
small, few equally spaced episodes not as much impairment as motor affected ones
35
what are prognostic indicators for MS
very difficult to predict ``` GOOD: female Present with optic neuritis Long interval between 1st and 2nd relapse Few relapses in 1st 5 years ``` ``` BAD: male Older age Multifocal symptoms and signs Motor symptoms and signs ```
36
what is the course of primary progressive MS
initial onset gets progressively worse - no remission - no relapses
37
what are the symptoms for primary progressive MS
spinal symptoms | bladder symptoms
38
what is devics disease
neuromyelitis optica spectrum disorder optic neuritis + myelitis autoimmune if aquaporin-4 antibodies present unknown cause if antibody negative
39
what is the treatment for devics disease
immunosuppression
40
what are the broad groups of treatment for MS
general health and diet treatment of relapse symptomatic treatment multi-disciplinary approach disease modifying treatment
41
what are the first steps to take in an acute relapse of MS
look for underlying infection exclude worsening of usual symptoms with intercurrent illness
42
what are the treatments for acute relapse of MS
oral prednisolone (IV) rehabilitation symptomatic treatment
43
what medical precaution is advised for people with MS
vaccinations - underlying viral infection s the cause of 25-30% further relapses
44
when do women sometimes have a period of fewer relapses followed by a period of increased risk of elapses
fewer relapses during pregnancy increased risk in the first 3 months post partum
45
what do disease modifying drugs do
do not stop progression of disease but can reduce number and severity of relapses
46
what are the first line disease modifying drugs in MS
s/c or i/m injections: Beta-interferons glatiramer acetate Oral treatments: Teriflunomide Dimethyl Fumarate
47
what are the side effects of first line disease modifying treatments
flu-like symptoms injection site reactions abnormalities of blood count and liver function
48
how effective are first line disease modifying treatments
reduce relapse rate by ~1/3 BUT non effect on progression of disability NOT a cure
49
what are the second line disease modifying treatments for MS
Natalizumab - Reduce relapse rate ~2/3 - Monthly infusion Fingolimod- tablets - Cardiac Alemtuzumub - Autoimmune thyroid disease/ Goodpastures/ immune thrombocytopenic purpura
50
what causes progressive multifocal leukencephalopathy (PML)
JC virus
51
what are the treatments and management for PML
immunosuppression - Natalizumab - Dimethyl fumarate - Fingolimod MRI annual JC antibody blood and urine 6 monthly
52
what are some of the individual treatments for symptoms of MS
Spasiticity-muscle relaxants/ antispasmodics/ physiotherapy Dysaesthesia-amitriptyline, gabapentin etc. Urinary-anticholinergic Rx, bladder stimulator/ catheterisation Constipation-laxatives Sexual dysfunction-sildenafil Fatigue-graded exercise, medication Depression-CBT, medication Cognitive-memory aids etc Tremor-aids/ pharmaceutical Vision/ oscillopsia-carbamazepine Speech/ swallowing-SALT Motor/ sensory impairment- multi-disciplinary team
53
who is involved in the multi-disciplinary team
``` MS nurse Physiotherapy Occupational therapy Speech and language therapy Dietician Rehabilitation specialists Continence advisor Psychology/psychiatry ```

NEURO (51 decks)

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