Multiple Sclerosis Flashcards
What is Multiple Sclerosis?
Chronic cell-mediated autoimmune disease
What is multiple sclerosis characterised by?
Demyelination of the CNS
Inflammatory plaques of demyelination disseminated in space and time
How many days are there usually between attacks of MS?
30 days
What are the classifications of the disease?
Relapsing-remitting
Seconday progressive
Primary progressive
What is relapsing-remitting?
Acute attacks followed by periods of remission
What is primary progressive?
Worsening disease and neurological symptoms from the start- no relapsing-remitting
What is secondary progressive?
Relapsing-remitting, now progressed and there is incomplete remission
How does multiple sclerosis present?
- 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)
What is one of the main presentations of Multiple sclerosis ?
Optic neuritis
What are the 2 main signs of multiple sclerosis?
- Uhthoff’s phenomenon
* Lhermitte’s syndrome
What is Uhthoff’s phenomenon?
Worsening of vision with rise in body temperature
What is Lhermitte’s syndrome?
Paraesthesia in limbs on neck flexion
What are the 2 methods of diagnosis for MS?
MRI
Lumbar puncture
What would you find in an MRI of someone with Multiple Sclerosis?
Plaques T2
What would you find in a lumbar puncture in someone with MS?
Oligoclonal bands in CSF
What is the management for a relapse of MS?
1g IV Methylprednisolone
every 24 hours for 3 days
What is the management for prevention of MS?
Beta-interferon
What is the management for sexual dysfunction?
Sildenafil
What is the management for spasticity?
Baclofen
Gabapentin
What are the main pathological features of MS?
CD4-mediated destruction of oligodendroglial cells
Humoral response to myelin binding protein
What are the radiological and pathological hallmarks of the disease?
Plaques of demyelination and eventual axonal loss
Due to MS being a disease of the CNS, what is not seen?
LMN lesions
What can be seen on an MRI of someone with MS?
Periventricular white matter lesions seen on MRI
What criteria is used for the diagnosis of MS?
The McDonald criteria
What is the management of an acute attack of MS that doesn’t respond to methyprednisolone?
Plasma exchange
What are the visual symptoms of MS?
optic neuritis:
optic atrophy
Uhthoff’s phenomenon
internuclear ophthalmoplegia
What are the sensory symptoms of MS?
pins/needles
numbness
trigeminal neuralgia
Lhermitte’s syndrome
What is the main motor symptom of MS?
Spastic weakness- usualloy in legs
What are the cerebellar symptoms of MS?
Ataxia
Tremor
What are the other possible symptoms of MS?
urinary incontinence
sexual dysfunction
intellectual deterioration
