Multiple Sclerosis Flashcards
What is MS?
An inflammatory demyelinating condition affecting the central nervous system, with formation of these plaques being disseminated in time and place
What does ‘disseminated in time and place’ mean?
The plaques develop at different times and within different locations of the brain
What are common sites for the demyelination to occur in MS?
Optic nerve
Spinal cord
Cerebellum
Peri-ventricular white matter
What are the causes of MS?
Autoimmune
Multifactorial - genetic, environmental, immunological factors
What are the main pathological findings in MS?
Varying degrees of inflammation
Perivascular inflammation and oedema
Neuronal loss with reactive astrocyte gliosis
Who usually presents with MS?
Peak incidence 20-40 years
F:M 2:1
More common in northern hemisphere
What are the symptoms of MS?
Motor: pyramidal weakness, gait abnormalities
Sensory: numbness, tingling, neuropathic pain, reduced proprioception and vibration
Cerebellar: incoordination, dysarthria, intention tremor, dysdiadokokinesis
Eyes: sudden loss of vision, double vision
Bowel/bladder: alteration of normal function
Fatigue, depression
What are the signs seen on examination in MS?
Limbs: spasticity, brisk reflexes, positive Babinski signs (plantar reflex)
Eyes: nystagmus, RPD, INO
Lhermitte’s phenomenon (electrical shock down spine and arms when head is bent forward)
Uthoff’s phenomenon (worsening of the symptoms with heat and exercise)
Hoffman’s reflex (flexion of the thumb upon tapping the nail or flicking the distal phalange of the middle finger)
What are the different patterns of disease in MS?
Relapse remitting
Secondary progressive
Primary progressive
Progressive relapsing
What is relapse remitting MS?
Unpredictable relapses of varying severity with remission in between
Attacks come on over days and recover over weeks
Average 1 attack per year
What is the most common type of MS?
Relapsing remitting
What is secondary progressive MS?
Relapses with incomplete recovery and acute relapses superimposed, leading to steady neurological decline and increased disability
Majority go on to develop secondary progressive
What is primary progressive MS?
Steady neurological decline with no periods of remission following the onset of symptoms
No true relapses, just a progressive decline
What is progressive relapsing?
Steady neurological decline from onset of symptoms with super imposed relapses
Rarest type
How is diagnosis of MS made?
Two episodes of symptoms suggestive of MS that last at lest 1 hour and are at least 30 days apart
MRI of brain and spinal cord showing plaques of demyelination
Bloods to rule out MS mimics
