MS- Case Flashcards
What 3 patterns can appear with MS?
- Relapsing remittinh-80% of new dx, periiods or remission.
↪️ then ppl will go on to have 2. 2o progressive: develops in 50% in first 10Y . Relapse becomes more frequent, w/ incomplete remission and progression. - 1o progressive: gradual but continually worsening sx from the dx time (10-15%)
Worsening of disability- intercurrent infx, unrelated, progression, relapse,
Involvment of optic nerve causes opric or retrobulbar neurotis.
✔️ classic: unilateral visual loss over hours to days assc w/ pain esp on movement of eye.
❗️Colour vision esp affected.
RULE: recovery.
What is seen in opric neuritis?
Swelling of the optic nerve head- papilloedema,
Whereas retrobulbar neuritis- theres nothing- pt sees nothing, dr sees nothing.
Both can be followed by optic atrophy.
What are 2 unusual but ver characteristic sx of MS?
- Uhthoffs phenomenon: effect of heat and exertion ⬆️ sx, esp weakness of legs and cisual loss (Inability to get out of hot bath)
- Lhermitte’s sign: electric shock like sense sations down the back and sometimes the thighs on bending neck (can occur in other dx affecting cervical cord)
PC of MS
New /worsened neuro sx/weakness/disability (new dx or relapse of known disease)
Probs due to established MS- UTIs,
‼️
How and when did the pt first present?
Course of illness to date- if relapsing- #/Freq/nature of relapses
If new: any episodes b4 dx- loss of vision in 1 eye( optic neuritis,) paraesthesis/ loss of continence (transverse myelitis)
Ask- bladder sx? - urgency/ urge incontinence/UTIs
Catherer?/self?
Infx/fever (may worsen disability/trigger relapse)
Fatigue V common ✔️
What else should we ask?
PMH- obstetric hx- relapses more common after post partum
FH- 10x in 1st degree.
SH- able to work? Allowances? Ambulant/ wheelchair? Able to transfer? Carers? Family, social services, district nurse, home help?
DH:Baclofen for spasticity/ anticholinergics for inconinence
IV steroids on recent relapse (methylprednisolone)
P/E of an MS pt:
General app: depressed, anxious, euphoric
CNS: cerebellar dysfx- staccato speech- silavista !
Cranial nerves/ optic atrophy, afferent pupillary relfex defect: Marcus Gunn pupil - usually at level of retina or optic nerve- pts pupil contricts less upon swinging light. So appearing to dilate when bright light swuang from unnafected eye to affected one.
Nystagmus: continued controlled involuntary ussualy eye movements
(47 types ha) caffeine and nicotine are stimulants
Peripheral nerves:
Spasticity legs>arms/clonus (UMN)
Pyramidal weakness legs>arms
Brisk reflexes/finger flexion jerks/+ve Hoffmans sign (UMN)
Bilateral externsor plantar reflexes (bilateral? So lesions affect bilateral sites!)
Absent abdo reflexes
Sensation affected in patchy distribution
Finger-nose ataxia in arms
Gait- spastic and ataxic
Urinalysis: as urinary infx is common.
Investigations
MRI BRAIN- shows best white matter lesions
MRI SPINE- id cord sx pc.
Visual evoked potentials- delayed (slow conduction in whire matter) LP- CSF analysis if uncertain dx 90%_ oligoclonal bands 40%- ⬆️ protein 30% ⬆️ mononuclear cells
How would u treat acute sx?
High dose corticosteroids for 3-5 days (speed recovery) - IV methyprednisolone-
Specialist advice regarding immunosupressants therapies like- azathioprine, IV immunoglobulin
No tx that alters disease course.
What about long term treatment?
MDT- physio, OT,
Interferon B for relapsing remitting: INF-B-1A/1B, Glatiramer acetate
Limoleic acid- sunflowe oil
Tx- for U incontinence and frequency.
Prognosis
Fav: sensory sx, optic neuritis, young.
Adverse:
Progressive, icomplete recover from initial attack,
Cerebellar ataxia, peristsent weakness.
MS- what happens?
Pt often female and young, 25s
MS affects the white matter of the CNS (brain and spinal cord) and ❌❌ peripheral nerves.
By definition, pt: must have at least 2 episodes (lesions) separated in both type and place (position within CNs)
