Multiple Sclerosis

Question 1

What is Multiple Sclerosis?

Answer 1

Chronic cell-mediated autoimmune disease

Question 2

What is multiple sclerosis characterised by?

Answer 2

Demyelination of the CNS

Inflammatory plaques of demyelination disseminated in space and time

Question 3

How many days are there usually between attacks of MS?

Answer 3

30 days

Question 4

What are the classifications of the disease?

Answer 4

Relapsing-remitting
Seconday progressive
Primary progressive

Question 5

What is relapsing-remitting?

Answer 5

Acute attacks followed by periods of remission

Question 6

What is primary progressive?

Answer 6

Worsening disease and neurological symptoms from the start- no relapsing-remitting

Question 7

What is secondary progressive?

Answer 7

Relapsing-remitting, now progressed and there is incomplete remission

Question 8

How does multiple sclerosis present?

Answer 8

• optic neuritis (loss of vision
• optic atrophy (afferent pupillary defect)
• loss of colour vision
• pins/needles and numbness
• spastic weakness: most commonly seen in the legs
• urinary incontinence
• sexual dysfunction
• Ataxia- drunk (difficulty walking, slurred speech, difficulty swallowing)

Question 9

What is one of the main presentations of Multiple sclerosis ?

Answer 9

Optic neuritis

Question 10

What are the 2 main signs of multiple sclerosis?

Answer 10

• Uhthoff’s phenomenon

* Lhermitte’s syndrome

Question 11

What is Uhthoff’s phenomenon?

Answer 11

Worsening of vision with rise in body temperature

Question 12

What is Lhermitte’s syndrome?

Answer 12

Paraesthesia in limbs on neck flexion

Question 13

What are the 2 methods of diagnosis for MS?

Answer 13

MRI
Lumbar puncture

Question 14

What would you find in an MRI of someone with Multiple Sclerosis?

Answer 14

Plaques T2

Question 15

What would you find in a lumbar puncture in someone with MS?

Answer 15

Oligoclonal bands in CSF

Question 16

What is the management for a relapse of MS?

Answer 16

1g IV Methylprednisolone
every 24 hours for 3 days

Question 17

What is the management for prevention of MS?

Answer 17

Beta-interferon

Question 18

What is the management for sexual dysfunction?

Answer 18

Sildenafil

Question 19

What is the management for spasticity?

Answer 19

Baclofen

Gabapentin

Question 20

What are the main pathological features of MS?

Answer 20

CD4-mediated destruction of oligodendroglial cells
Humoral response to myelin binding protein

Question 21

What are the radiological and pathological hallmarks of the disease?

Answer 21

Plaques of demyelination and eventual axonal loss

Question 22

Due to MS being a disease of the CNS, what is not seen?

Answer 22

LMN lesions

Question 23

What can be seen on an MRI of someone with MS?

Answer 23

Periventricular white matter lesions seen on MRI

Question 24

What criteria is used for the diagnosis of MS?

Answer 24

The McDonald criteria

Question 25

What is the management of an acute attack of MS that doesn’t respond to methyprednisolone?

Answer 25

Plasma exchange

Question 26

What are the visual symptoms of MS?

Answer 26

optic neuritis:
optic atrophy
Uhthoff’s phenomenon
internuclear ophthalmoplegia

Question 27

What are the sensory symptoms of MS?

Answer 27

pins/needles
numbness
trigeminal neuralgia
Lhermitte’s syndrome

Question 28

What is the main motor symptom of MS?

Answer 28

Spastic weakness- usualloy in legs

Question 29

What are the cerebellar symptoms of MS?

Answer 29

Ataxia
Tremor

Question 30

What are the other possible symptoms of MS?

Answer 30

urinary incontinence
sexual dysfunction
intellectual deterioration