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Yr 3 neuro > MS > Flashcards

MS Flashcards

1
Q

definition of MS

A

Inflammatory demyelinating disease of the CNS

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2
Q

different classifications of MS

A

relapsing remitting

clinically isolated syndrome

primary progressive MS

marburg variant

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3
Q

relapsing remitting MS

A
  • Commonest
  • Clinical attacks of demyelination
  • Complete recovery in between attacks
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4
Q

clinically isolated syndrome MS

A
  • Single clinical attack of demyelination
  • Doesn’t qualify as MS
  • 10-50% progress to MS
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5
Q

primary progressive MS

A
  • Steadily accumulation of disability
  • No relapsing-remitting
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6
Q

marburg variant of MS

A
  • Severe fulminant variant of MS
  • Leading to advanced disability of death in a period of weeks
  • Distinct from acute disseminated encephalomyelitis (ADEM)
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7
Q

acute disseminated encephalomyelitis

A

Uncommon acute monophasic CNS demyelinating condition – thought to be a post-viral autoimmune phenomenon

Intubation may be needed

Treated high dose steroids

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8
Q

Neuromyelitis optica (Devic’s syndrome)

A

Rare demyelinating condition which is typified by optic neuritis and extensive transverse myelitis.

Associated with anti-aquaporin-4 antibodies

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9
Q

aetiology of MS

A

Unknown

Autoimmune bases with postulated env trigger in genetically susceptible

Immune mediated damage to CNS myelin = impaired conduction

Grey matter atrophy

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10
Q

RF for MS

A
  • EBV exposure
  • Prenatal vit D levels
  • Strong concordance in monozygotic versus dizygotic twins(25% vs 3%)
  • Geographical variation – (temporate>tropical) with individuals carrying risk of pre-pubertal (<13yr) country of origin
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11
Q

epidemiology of MS

A

Prev in UK 1 in 1000

Rare in far east

Female more

20-40yrs

increasing incidence with latitude in some parts of the world (NB: adult migrants take their risk with them; children acquire the risk of where they settle) - leading to hypothesis of roles of vitamin D and infection

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12
Q

systems MS can effect

A

usually monsymptomatic, symptoms may worsen with heat eg hot bath/exercise

optic

sensory

motor - corticospinal tract

psychological

autonomic

uhthoff’s phenomenon

bladder

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13
Q

optic effects of MS

A

optic neuritis:

  • Unilateral deterioration in visual acuity and colour perception
  • Pain on eye movement
  • reduced rapid central vision

diplopia

hemianopia

visual phenomena eg on exercise

bilateral internuclear ophthalmoplegia

pupil defects

argyll robertson pupil - The pupil is constricted and unreactive to light, but reacts to accommodation. The iris may be patchily atrophied, irregular, and depigmented

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14
Q

motor Sx of MS

A
  • Limb weakness
  • Spasms
  • Stiffness
  • Heaviness
  • myelitis
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15
Q

sensory sx of MS

A
  • Pins and needles
  • Numbness
  • Burning
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16
Q

psychological sx of MS

A
  • Depression
  • Psychosis
  • accidents
  • amnesia
  • reduced executive functioning
17
Q

autonomic sx of MS

A
  • Urinary urgency
  • Hesitancy
  • Incontinence
  • Impotence
18
Q

uhthoff’s phenomenon

A
  • Transient increase or recurrence of symptoms due to conduction block precipitated by a rise in body temp
19
Q

signs of optic nueritis - MS

A
  • Impaired acuity (most common)
  • Loss of colour vision
  • On fundoscopy in active disease – swollen optic nerve head, in chronic disease may be optic atrophy
20
Q

signs of MS

A

optic neuritis

visual field testing - Central scotoma (optic nerve not affected) or field defects (optic radiations affected)

relative afferent pupillary defect - swinging torch test = Both pupils contractwhen light is shone on the unaffected side, both pupils dilate when light is swung to the diseased (eye).

intranuclear opthalmoplegia - Lateral horizontal gaze = failure of adduction of the contralateral eye, Indicates lesion of contralateral medial longitudinal fasciculus

sensory - Parasthesia (vibration and joint position sense loss more common than pain and temp), dysaesthesia, trigeminal neuralgia

motor - UMN signs – spastic weakness, brisk reflexes

cerebellar:

  • Limb ataxia (intention tremor, past-pointing and dysmetria on finger nose and heel-shin test)
  • Dysdiadochokinesis
  • Ataxic wide-based gait
  • Scanning speech
  • falls

lhermitte’s phenomenon - Electric shock like sensation in arms and leds, precipitated by neck flexion

21
Q

Ix for MS

A

Diagnosis based on 2 or more CNS lesions with corresponding symptoms, separated in time and space (McDonald criteria)

  • LP
    • Microscopy to exclude other infective or inflamm causes
    • CSF electrophoresis shows unmatched oligoclonal bands that are not present in serum - suggest CNS inflammation
  • MRI-brain, cervical and thoracic spine with gadolinium
    • Plaque detection highlighted as high signal lesions
    • Gadolinium enhancement indicates an active lesion.
    • exclude other causes eg cord compression
  • Evoked potentials
    • Visual, Auditoy or somatosensory evoked potentials (VEP, BEP, SEP) may show delayed conduction velocity
    • VEPs are delayed in 90% pts with MS
22
Q

pathology of MS

A

inflammatory plaques of demyelination in the CNS disseminated in place and time, ie occuring at multiple sites with>30d between attacks

demyelination heals poorly = axonal loss

>80% pts develop progressive disability

23
Q

dx of MS

A

clinical

made by a consultant neurologist using criteria, after alternative dx have been excluded

early dx reduces relapse rates and disability so refer as soon as MS is suspected

24
Q

progression of MS

A

most pts have relapsing remitting with initial recovery between relapses

with time remission becomes incomplete - disability accumulates (secondary progression)

primary progressive MS - 10% pts, steadily progressive disability in the abscence of relapses

minority of patients experience no progressive disablement at all

pregnancy Does not alter the rate of progression: relapses may reduce during pregnancy and increase 3–6 months afterwards, but return to their previous rate thereafter

25
Q

Gi sx of MS

A

swallowing disorders

constipation

26
Q

sexual/GU sx of MS

A

erectile dysfunction

anorgasmia

urine retention

incontinence

27
Q

criteria to dx MS

A
28
Q

Devic’s syndrome

A

(=Neuromyelitis optica, NMO.)

MS variant with transverse myelitis, (loss of motor, sensory, autonomic, reflex, and sphincter function below the level of a lesion), optic atrophy, and anti-aquaporin 4 antibodies

29
Q

Lhermitte’s sign

A

Neck flexion causes ‘electric shocks’ in trunk/limbs.

(Also +ve in cervical spondylosis, cord tumours and low B12.)

30
Q

uhthoff’s phenomenon

A

worsening of sx with heat eg bath

31
Q

charles bonnet syndrome

A

rare

reduced acuity/temporary blindness +- complex visual hallucinations of faces, as well as animals, plants and trees

32
Q

pulfrich effect

A

unequal eye latencies - causing disorientation in traffic as straight trajectories seem curved and distances are misjudged on looking side ways

33
Q

Mx of MS acute relapse

A

IV Methylprednisolone
consider plasma exchange

34
Q

mx for relapsing remitting MS

A

Immunomodulation - interferon B
sensory sx - anticonvulsant/antidepressant
increased tone - baclofen, physio
tremor - propranolol
gait - fampridine
urinary frequency - oxybutinin
fatigue - amantadine
oscillopsia (visual fields appear to oscillate) - gabapentin

35
Q

mx of secondary progressive MS

A

siponimod or methylprednisolone

36
Q

mx for primary progressive MS

A

biologics - ocrelizumab

37
Q

complications of MS

A

UTI
osteopenia, osteoporosis
depression
visual impairment
Erectile dysfunction
cognitive impairment
impaired mobility

38
Q

px of MS

A

variable
poor px - frequent relapse, motor/cerebellar onset
higher MRI lesion burden equates to poorer px
good px - female, sensory/optic neuritis onset

39
Q

monitoring for MS

A

review every 12 mo
check DM, vit B12, vit D, thyroid (hypo)
MRI 6mo after starting DMARDs
yearly MRI in stable (also looks for complications of rx)
spinal cord imaging of spinal cord phenotype

Yr 3 neuro (32 decks)

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