Multiple sclerosis Flashcards
What is MS
Multiple sclerosis is chronic cell-mediated autoimmune disorder characterised by demyelination in the central nervous system
Epidemiology of MS
3 times more common in women
most commonly diagnosed in people aged 20-40 years
much more common at higher latitudes (5 times more common than in tropics)
Which part of the nervous system is affected by MS typically
CNS
Causes of MS
Multiple genes Epstein–Barr virus (EBV) Low vitamin D Smoking Obesity
Most common pattern of MS
Relapsing-remitting disease
What is internuclear ophthalmoplegia
Unilateral lesions in the sixth nerve causes a condition called internuclear ophthalmoplegia.
Internuclear refers to the nerve fibres that connect between the cranial nerve nuclei that control eye movements (3rd, 4th and 6th cranial nerve nuclei).
The internuclear nerve fibres are responsible for coordinating the eye movements to ensure the eyes move together.
What is a conjugate lateral gaze disorder
When looking laterally in the direction of the affected eye, the affected eye will not be able to abduct due to CNVI palsy
Examples of focal weakness associated with MS
Bells palsy
Horners syndrome
Limb paralysis
Incontinence
Examples of focal sensory symptoms associated with MS
Trigeminal neuralgia
Numbness
Paraesthesia (pins and needles)
Lhermitte’s sign
What is Lhermitte’s sign
An electric shock sensation that travels down the spine and into the limbs when flexing the neck. It indicates disease in the cervical spinal cord in the dorsal column. It is caused by stretching the demyelinated dorsal column.
What is clinically isolated syndrome(CIS) in MS
Describes the first episode of demyelination and neurological signs and symptoms
Patients with clinically isolated syndrome may never have another episode or develop MS. If lesions are seen on MRI scan then they are more likely to progress to MS.
What is relapsing-remitting MS
It is characterised by episodes of disease and neurological symptoms followed by recovery. In MS the symptoms occur in different areas with different episodes
Classification of relapsing-remitting MS
Active: new symptoms are developing or new lesions are appearing on MRI
Not active: no new symptoms or MRI lesions are developing
Worsening: there is an overall worsening of disability over time
Not worsening: there is no worsening of disability over time
What is secondary progressive MS
Secondary progressive MS is where there was relapsing-remitting disease at first, but now there is a progressive worsening of symptoms with incomplete remissions. Symptoms become more and more permanent.
What is primary progressive MS
there is a worsening of disease and neurological symptoms from the point of diagnosis without initial relapses and remissions.
