MS - Signs and Symptoms Flashcards
1
Q
Why is depression huge with MS
A
you do not know what is going to happen
exacerbations
and the decline of function
2
Q
80 to 90% of MS pts complain of
A
fatigue
3
Q
What is primary fatigue
A
when MS is causing the fatigue
4
Q
What is secondary fatigue
A
if you are fatigued you do less and if you do less you become more fatigued
5
Q
What are the two biggest complaints from pts with MS
A
fatigue and gait disturbances
6
Q
How does MS present (general)
A
MS can present in any number of ways, depending on where the lesions are located
7
Q
what are some of the most frequent reported MS symptoms (7)
A
Fatigue: 88% Gait Disturbance: 87% - some foot drop, quad weakness, gastroc spasticity B/B issues: 65% Pain & other sensations: 60% Visual disturbance: 58% Cognitive deficits: 44% Tremors: 41%
8
Q
What are some other common motor symptoms
MS
A
Motor Symptoms Spasticity/spasms Weakness Contractures (over time) Gait disturbance Fatigue Cerebellar/Bulbar sx -Dysphagia -Nystagmus -Intention tremor
9
Q
What are some common sensory symptoms
A
Numbness
Pain (most often musculoskeletal)
Paresthesia
Dysesthesia
10
Q
What are some visual symptoms
MS
A
↓ acuity
Diplopia
Scotoma
11
Q
What are some B/B symptoms
A
Urgency Frequency Incontinence Urinary retention Constipation
12
Q
What are some sexual symptoms
A
Impotence
↓ genital sensation
↓ genital lubrication
13
Q
What are some cognitive and emotional symptoms?
A
Depression IEED (Lability) ↓ judgment/memory Agnosia ↓ Conceptual thinking, attention, concentration
14
Q
What is Scotoma
A
a partial loss of vision or blind spot in an otherwise normal visual field.
15
Q
What is IEED
A
Involuntary Emotional Expression Disorder - labile
16
Q
What is Agnosia
A
The loss of the ability to recognize objects, faces, voices, or places. It’s a rare disorder involving one (or more) of the senses. Agnosia usually affects only a single information pathway in the brain.
17
Q
What is the relationship between strength and fatigue?
A
Can be present even if strength is normal
18
Q
What are some tests and measures for fatigue
A
MFIS (Modified Fatigue Impact Scale)
FSS (Fatigue Severity Scale)
19
Q
Primary fatigue aka
A
Lassitude
20
Q
Lassitude aka
A
Primary fatigue
21
Q
fatigue is
A
weariness, lethargy, stupor, exhaustion, sluggishness, tiredness
22
Q
How is fatigue with MS different than fatigue w/o MS
A
More prevalent in afternoons & evenings
Worsening of fatigue with exercise/heat
Does not correlate with degree of impairment or functional limitations
23
Q
What is the theory behind fatigue and MS
A
Decreased conductivity leads to muscles getting more tired over time
24
Q
What are some causes of secondary fatigue?
A
Infection Spasticity Ataxia Weakness Depression Sleep deprivation Polypharmacy Poor diet Deconditioning Movement limitations Changes in body temp Emotional stress
25
How can you tell if fatigue is primary or secondary
if you workout and it gets better then it is secondary
26
How can working out help fatigue?
Fear of fatigue leads to a lifestyle of inactivity for many people with MS -->physical deconditioning & disuse
Exercise, when administered correctly and appropriately, can help to modulate fatigue symptoms and prevent deconditioning
27
What is the theory behind MS and getting too hot/working out to hard.
Muscles can only work with in a certain temp range to create neuro potentials. People with MS have a smaller range.
The hotter they get the more fatigue they become because they cannot produce action potentials
28
When working with a client with MS what do you have to consider
- Carefully consider the type of exercise given to people with MS, as they do have a decreased ability to tolerate large amounts of exercise
- There is a significant danger of injury to a person with MS from over-exercising, as fatigue may lead them to start using inappropriate movement patterns or increase falls risk
- Scheduling exercise at times of increased energy may be more effective, although the patient may want to use those times for other activities
29
What is a pseudoexasperation?
can be caused by working out to hard. You think it is an exasperation but in actuality they are just excessively tired
30
Is anesthesia common with MS pts?
Anesthesia is rare, paraesthesia and dysesthesia are more frequent
31
What is paraesthesia?
tingling, pricking, numbness, pins & needles, “falling asleep”
32
What is dyesthesia?
Abnormal sensations such as burning, itching, electric shock, wetness, tight banding
“MS Hug” or “Girdle-Band” sensation
33
Why would people with MS test positive for a L'Hermitte's Sign
dorsal column demyelinating change
A shock like sensation in the spine or LEs produced by rapid neck flexion, as in coughing, and is indicative of dorsal column demyelinating damage
Not limited to MS only; can be caused by other conditions
(has to be rapid)
34
What is Trigeminal Neuralgia (aka)?
Where is the damage?
(aka tic douloureux): Found in a small # of patients (~3%), results from demyelination of CN V in the pons region
CN V serves the forehead, eye, cheek, jaw
35
What are the branches of the trigeminal nerve
V1 - opthalmic -S
V2 - Maxillary - S
V3 - Mandibular - S & M
36
Is tic douloureux common?
No (3%). Rarely the first sx, usually appears in advanced stages of MS
37
What is the treatment for Tic Douloureux
Tx: Anticonvulsants, antidepressants, surgical decompression
38
Is weakness a primary or secondary symptom?
Both
39
Primary weakness with MS is due to
```
Primary Weakness: from plaques in the motor cortex or pyramidal tracts
Can be (B), (U), UE or LE, mimicking other diseases
```
40
Secondary weakness with MS is due to
Secondary Weakness: due to disuse
As a result of the weakness and fatigue, pts move and exercise less, greatly exacerbating the 1° weakness
Although the 1° weakness cannot be affected by exercise, the 2° weakness can
41
Which symptom do people not normally correlate with their MS?
Visual Disturbances
42
Visual Disturbances:
What is it?
What is a common complaint?
What does it impair?
Decrease visual acuity, visual field deficits, blurred vision, diplopia, transient or permanent blindness, loss of central vision, tracking problems, optic neuritis
Optic Neuritis: a common presenting complaint – a transient, abrupt, loss of vision over 2-3 days
Impairs ADL’s, IADLs (i.e. driving), ambulation & functional activities, and recreation
43
What is Optic Neuritis?
a common presenting complaint – a transient, abrupt, loss of vision over 2-3 days
44
Spasticity and MS and why would it occur
Occurs due to UMN involvement
Spasticity, hyperreflexia and pathologic reflexes are part of the syndrome
Spasticity may worsen over time or with exacerbations
Can co-exist with weakness
45
Heat Sensitivity and MS
-Common finding in MS exacerbation: transient symptom worsening w/ ↑ of core body temp
-Uhthoff’s symptom: a condition where small ↑’s in body temp cause worsening of sx (esp. of optic neuritis)
-Cause can be external (environmental) or internal (vigorous exercise)
-Range of temp ↑ with (+) sx: 0.180 F to 4.140 F
Normal temp change throughout the day: 0.90 F
Lowest temp in early AM, highest in evening
46
What is Uhthoff's Symptom?
a condition where small ↑’s in body temp cause worsening of sx (esp. of optic neuritis)
47
What is the theory behind heat sensitivity and MS. What is this theory called?
Neuroblockade Hypothesis: The ability of demyelinated axons to conduct action potentials (AP) decreases as temp rises
A large safety margin exist for AP voltage to ensure transmission along the axon
The safety margin in a demyelinated axon at normal temp allows the AP to jump a demyelinated region to reach a node of Ranvier
W/ hyperthermia, the AP’s voltage safety margin is ⬇, & there is less jumping across demyelinated regions – inability to propagate APs
48
Weather and MS
For some, humidity is worse than heat, and in a rare group, cold will exacerbate symptoms
This does not preclude the use of focal heat to treat musculoskeletal disorders, but usually contraindicates the use of heated therapeutic pools
49
Ataxia and MS
Usually due to cerebellar involvement, occasionally can be from posterior column involvement
Dysmetria, dysdiadochokinesia, tremor and vestibulopathy are also possible
If vertigo is present, it must be differentiated from peripheral vestibular complaints
50
Tremors and MS
Cerebellar involvement – “Action tremors”
Intention tremor
Rhythmic oscillations of limb about the target (worsens as it nears)
Postural tremor
Affects more proximal ms, head/trunk may be involved
Emerges when pt attempts to maintain a posture & may persist or worsen w/ goal-directed mvt of the limb(s)
51
Pain and MS
In addition to pain from sensory disturbances (Dysesthesia, L’Hermitte’s sign, trigeminal neuralgia), people with MS may have pain of other origins
Spasms from spasticity
Musculoskeletal pain from inappropriate & inefficient movement patterns due to weakness, disuse atrophy, & contractures
52
Bladder and MS
The bladder is affected in 80-90% of people with MS, and is more common in spinal MS than cortical MS
Earliest complaints are of frequency and urgency
The most common clinical findings are either a failure to empty (flaccid bladder) or store (spastic bladder)
May be a site of infection 20 catheterization or urinary back-flow
53
What is the difference between flaccid and spastic bladder
failure to empty (flaccid bladder) or store (spastic bladder)
54
Speech and language and MS
Aphasia (Broca’s > Wernicke’s)
Dysarthria
Dysphagia
Dysphonia – hoarseness, raspy voice, change in pitch 20 difficulty with volume and breath control
55
What is Dysarthria
motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened. The person with dysarthria cannot control his or her tongue, larynx, vocal cords, and surrounding muscles, which makes it difficult for the person to form and pronounce words.
56
What is Dysphagia
swallowing difficulties.
57
What is Dysphonia
abnormal voice. It is also known as hoarseness.
58
Sexual Dysfunction and MS, direct and indirect causes
Direct effect of MS caused by neurological impairment
Erectile difficulties
Orgasmic dysfunction
Decreased libido
```
Indirect effect caused by other MS sx
Fatigue
Spasticity
Depression
Bladder/bowel dysfn
```
59
Psychiatric and MS
Euphoria is often seen in late stages
Depression is usually reactive, but can be primary as well
Suicide rates in MS is 7.5x higher than norms
Depression can add to fatigue and therefore is usually treated by use of antidepressants
Most common cognitive changes are memory loss, impaired safety awareness, diminished attention, frontal affect
Psychosis is a rare complication, usually due to complications from steroid therapy
60
Musculoskeletal Issues and MS
The weakness and fatigue that occur due to MS cause a series of secondary problems which are of great importance to rehab professionals
Musculoskeletal issues can occur due to inappropriate movement patterns 20 weakness, fatigue or spasticity
Overuse syndromes or tendonitis
Contractures
61
Changes in Respiration and MS, also primary and secondary causes
- Respiratory involvement commonly affects 20% of patients with MS
- Due to a combination of primary & secondary symptoms
- Primary- loss of motor control to respiratory muscles
- Secondary- deconditioning, postural changes, aspiration pneumonia, medication S/E
- Furthers the vicious cycle of MS fatigue
62
Posture and MS
- Changes in posture result from prolonged sitting can significantly affect strength and function
- Even if the pt is severely involved, he/she can benefit from positioning out of the flexed pattern
- Poor posture in an immobile pt can lead to skin breakdown, contractures, and respiratory complications
63
Balance loss and MS, also primary and secondary causes
Due to a combination of primary and secondary effects
Primary: Weakness, fatigue, spasticity, ataxia, sensory loss, diminished motor control, visual loss, depression
Secondary: secondary weakness, contractures
64
Other secondary complications due to MS
Osteoporosis
Combination of disuse and steroid use
Infections
UTI, respiratory, decubitis ulcers
