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Neurology > MS > Flashcards

MS Flashcards

1
Q

What is MS?

A

Inflammatory demyelinating disorder of the CNS

Plaques disseminated in time and place

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2
Q

Are women or men more commonly affected by MS?

A

Female: male = 3:1

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3
Q

What are the different clinical courses of MS?

A

Relapsing remitting; 90%
Secondary progressive
Progressive relapsing
Primary progressive

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4
Q

What are the clinical features of MS?

A 
Pyramidal dysfunction 
Optic neuritis
Sensory symptoms
Lr urinary tract dysfunction 
Cerebellar and brain stem features
Cognitive impairment
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5
Q

What are the symptoms of pyramidal dysfunction in MS?

A 
Increased tone
Spasticity
Weakness
Extensors of upper limbs
Flexors of lower limbs
UMN LESION
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6
Q

What are the symptoms of optic neuritis?

A

Painful visual loss on eye movement
RAPD
Central scotoma

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7
Q

How long will optic neuritis last in MS?

A

1-2 weeks

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8
Q

What sensory symptoms are associated with MS?

A 
Pain 
Paraesthesia
Dorsal column loss; proprioception and vibration 
Numbness
Trigeminal neuralgia
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9
Q

What cerebellar symptoms are associated with MS?

A 
Dysarthria
Ataxia
Nystagmus
Intention tremor
Past pointing
Pendular reflexes
Dysdiadokinesis
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10
Q

Will cerebellar problems be contra or ipsilateral?

A

Ipsilateral

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11
Q

What brain stem dysfunctions are commonly seen in MS?

A

Diplopia; CN6 palsy

Facial weakness; CN 7 palsy

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12
Q

What causes internuclear ophthalmoplegia?

A

Medial longitudinal fasiculus

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13
Q

What will be seen in INO?

A

Distortion of binocular vision
Failure of adduction; diplopia
Nystagmus in abducting eye
Lag

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14
Q

What lr urinary tract dysfunctions are assoc with MS?

A

Increased tone of bladder neck; retention

Irritability of detrusor muscle; frequency, nocturia, urgency, incontinence

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15
Q

What is used for fatigue management in MS?

A

Amantadine
Modafinil if sleepy (?)
Hyperbaric oxygen
Fatigue management via occupational therapists

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16
Q

How is MS diagnosed?

A

At least 2 episodes suggestive of demyelination
Dissemination of plaques in time and place
Alternative diagnoses excluded

17
Q

What scans are done for the diagnosis of MS?

A

MRI - T2 weighted
FLAIR
CT ALWAYS BEFORE LP PERFORMED
Neurophysiology

18
Q

What is the DDx of MS?

A 
Vasculitis 
Sarcoid (tend to have pulmonary and skin involvement along with arthralgia and uveitis) 
Vascular disease
Structural lesion
Infection; HIV, syphilis, lyme disease 
Metabolic disorder; B12/folate
19
Q

What blood tests are routinely performed in the work up of potential MS?

A 
PV, CRP, FBC
U+Es, eGFR
LFTs
Auto-antibody screen
Borrelia (lyme), HIV, syphilis
B12 and folate
Vit D
20
Q

What is seen on CSF of those with MS?

A

Oligoclonal bands in 90+% of cases

21
Q

What is the treatment of an acute relapse of MS?

A

Mild - symptomatic
Moderatie; oral methylprednisolone 500 mg for 5 days
Severe; IV methylprednisolone 1000 mg for 3 days

22
Q

What are some common adverse effects of MS?

A 
Osteoporosis
Pancreatitis
Diabetes
Hypertension 
Psychosis 
AVN of hip
23
Q

What is the symptomatic tx for pyramidal dysfunction?

A

Physio
Occupational therapy
Anti-spasmodic agents
Don’t always want to get rid of spasticity; if muscles very weak, the spasticity of them will be the only thing allowing the patients to stand up and walk

24
Q

What are the anti-spasmodic agents used in spasticity?

A

PO; baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/ phenol

25
Q

What are the treatments for the sensory symptoms assoc with MS?

A 
Anticonvulsant e..g gabapentin
Anti-depressant; amitriptyline
Tens machine
Acupuncture
Lignocaine infusion
26
Q

What is the treatment for lower urinary tract dysfunction?

A

Bladder training
Anticholinergics; oxybutynin
Desmopressin
Catheterisation

27
Q

What are the 1st line disease modifying drugs used in MS?

A

Interferon beta; avonex, rebif, betaseron, extavia
Glitiramer acetate
Tecfidera, aubagio

28
Q

What are the 2nd line disease modifying drugs used in MS?

A

Monoclonal Ab; tysabri, ocrevus

Fingolimod, cladrabine

29
Q

What are the 3rd line disease modifying drugs used in MS?

A

Mitoxantrone, lemtrada

HSCT (stem cell transplantation)

30
Q

What is a very serious side effect associated with tysabri?

A

If the patient is infected with JC virus; can activate and cause PML

31
Q

What is PML?

A

Progressive multifocal leukoencephalopathy; fatal disease characterized by progressive inflammation of the white matter of the brain at multiple locations

32
Q

What is the mode of action of tysabri?

A

Prevents leucocytes entering the BBB and therefore prevents autoinflammation

Neurology (48 decks)

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