multiple sclerosis Flashcards
what does the affection of the CNS in MS look like ?
optic nerve -optic neuritis
spinal cord - myelitis
brainstem - brainstem syndrome
what are the symptoms of optic neuritis ?
pain on eye movement
blurred patchy vision
central field loss
loss of color vision ( red)
what are the signs of optic neuritis ?
RAPD
disc swollen
central scotoma
decreased visual acuity
Ishihara negative
what are the symptoms of myelitis ?
heavy legs
tight band around the trunk
urinary frequency and urgency
constipation
sexual dysfunnction
what is the spinal cord syndrome ?
UMN lesion , spastic paraplegia
gait
increased tone
brisk reflexes
sphincter dysfunction
what is the brainstem/cerebellar syndrome ?
double vision
vertigo
slurred speech
unsteady gait
slurred speech
facial sensory, neuralgia
what are the signs of brainstem or cerebellar syndromes?
INO internuclear ophthalmoplegia (ipsilateral affection)
nystagmus
facial paraesthesia
dysarthria
what is lehrmittes phenomenon ?
when you ask the patient to bring their chin closer to their chest they feel an electric pain down their spine
what is uhtoff’s phenomenon ?
symptoms increase with heat
what are the paroxysmal MS symptoms ?
neuropathic pain
lehrmitte
trigeminal neuralgia
seizures
MS hug
what is the difference between a true relapse and pseudo-relapse ?
true relapses last for more than 24 hours with no infection or fever
a pseudo relapse will last for more than 24 hours but will be accompanied by a fever
what are the tests required for MS ?
MRI
VERs visual evoked response
CSF examination through a lumbar puncture
where would you find MS lesions in the brain on MRI ?
juxtacortical
periventricular
infratentorial
spinal cord
how can dissemination in time be confirmed ?
on a clinical level : 2 attacks ( the first attack plus a relapse )
on a radiological level : McDonalds MS
what are the different disease courses of MS ?
Radiologically isolated syndrome ( not considered MS)
Clinically isolated syndrome
Relapsing remitting MS
Secondary progressive MS
Primary progressive MS
what is CIS ?
a single attack compatible with MS , which is isolated in time and may or may not be disseminated in space usually associated with young adults
what is RRMS ?
got an attack , was put on steroids then got another attack
what is SPMS ?
got ann attack was given steroids and showed slight improvement then the second attack was worse
what is PPMS ?
the worst prognosis
steady increase in disability without any attacks
what do we find in the CSF of MS patients ?
oligoclonal bands
if RRMS is left untreated what is the end result ?
SPMS
how do we clinically asses the disease severity ?
EDSS
MSFC
what does MSFC test ?
ambulation speed and ambulation distance
how is cognition measures in MSFC ?
PASAT
symbol digit modality test
9 hole peg test
what are the different levels for the expanded disability status scale ?
as soon as he needs assistance to walk - automatically at 5
restricted to wheelchair - 7
restricted to bed - 8
can’t swallow or talk - 9
what is thee gold standard for assessing clincal disease severity ?
EDSS
what are the predictors of conversion into CDMS ?
younger age
female patient
positive family history
cigarette smoking
cortical lesions
periventricular lesions
asympt post fossa lesions
