MS Flashcards
what is Multiple Sclerosis
Chronic Inflammatory demyelinating disease of the CNS
Prevalence of MS and average age of onset
commonest cause of neurological deficiency in adults
average onset 20-40 Y O
0.1% of population in UK
Rf of MS
vit D defic
further from equator
fam history
childhood ebv exposure
DDx of MS
sarcoidosis
sle
diff types of MS
relapsing remitting
secondary progressive
primary progressive
progressive relapsing
which type of ms in msot common
relapsing remitting (80%)
what is secondary progressive MS
initally relpase n remiting then decline without remission
what is primary prgroessive MS
steady decline - prgoressive from the start
what is progressive relapsing
steady decline from start w superimposed attacks
what kind of hypersensitivty reactin in MS
type IV (4x types and type 4)
what is charcots triad (neurological vs cholangitis)
MS = nystagmus, dysarthria, intention tremor
fever jaundice RUQ pain
what are clinical features of MS
DEMYELINATION Diplopia Eyemovement painful (optic neuritis) Motor weakness nYstagmus Elevated temp worsens (Uhthoffs) Lhermittes sign Intention tremor Neuropathic pain Ataxia Talking slurred (dysarthria) Impotence (erectile dystfunction) Overactive bladder Numbness (pins n needles)
in terms of plaque deposition - CFs on plaques in motor pathway
muscle weakness
tremor
ataxia
paralysis
in terms of plaque deposition - CFs on plaques in brainstem
dysarthria - concious movements (eating talking)
unconcious (swallowing)
in terms of plaque deposition - CFs on plaques in sensory from skin
paresthesias
Lhermittes sign - electric shock runs down back and radiates to limbs on bending neck forwards
in terms of plaque deposition - CFs on plaques in optic nerve
optic neuritism - loss of vision
central vision loss
diplopia
painful eye movements
in terms of plaque deposition - CFs on plaques in autonomic nervouse system
erectile dysfunction
bowel and bladder symptoms (overactive bladder)
pathophysiology of MS
type IV t cell mediated hypersensitivyt reaction (delayed hypersensitivyt)
autoantibodies vs myelin (OLIGODENDROCYTES CELL BASED SPECIFIC)
cytokines - inflam - discrete plaques of myelination = obstruct conduction
myelin sheath can regen - not as good = heat dependent (UHTHOFFS PHENOMENON)
repeated = axonal loss
= INCOMPLETE RECOVERY BETWEEN ATTACKS
what is Uthoffs phenomm
in MS
symptoms worse when hot
i.e post hot bath
due to heat slowing down conduction
Dx of MS criteera
McDonalds
2+ attacks with demyleination plauques
DISEMINATED IN SPACE AND TIME (dr who tardis)
exclude all other causes
Dx of MS
MRI- tries to identify demyelinating plaque or exclude other causes
CSF analysis - shows inflammatory markers in CSF
No inflammation in bloods. oligoclonal IgG bands (high conc)
electrophysiology - delayed nerve conduction evoked potentials
Management of MS
NO CURE relapse and remitting - acute attacks = IV methylprednisolone steroids = disease mod chronic - alemtuzumab (CD52 monoclonal antibody) or Natalizumab SYMPTOMATIC antispastic - baclofen antidepress - SSRI sertaline tremor - BBs - propanolol (CI in asthma) nerve pain - gabapentin
