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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is Multiple Sclerosis?

A

A disease involving relapsing episodes of immunologically mediated (T-cell) demyelination in the CNS, leading to neurological degeneration

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2
Q

In what groups does MS most commonly present?

A

1/1000 UK population
2:1 female preponderance
Age of onset 20-45 years
Genetic predisposition (HLA-DR2)

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3
Q

Where are MS plaques most commonly seen?

A 
Optic nn
Angles of lateral ventricles
Cerebellar peduncles
Brainstem
Dorsal/corticospinal tracts
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4
Q

What are the common sx of MS?

A 
Visual disturbance (optic neuritis)
UMN deficit
Sensory deficit
Cerebellar signs
Brainstem signs
Cognitive impairment
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5
Q

What are the sx/signs of optic neuritis?

A 
Blurring of vision over hrs/days
Mild ocular pain, worse on movement
Loss of colour vision
Diplopia
Recovery w/i 2mo
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6
Q

What are the sx/signs of UMN deficit?

A

Paraparesis
Hemiparesis
Monoparesis

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7
Q

What are the sx/signs of sensory deficit?

A

Paraesthesia
Proprioceptive loss
L’Hermitte’s sign - tingling sensations down arms/legs on neck flexion (post cervical lesions)

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8
Q

What are the cerebellar signs of MS?

A

Intention tremor
Nystagmus
Vertigo
Dysarthria

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9
Q

What are the brainstem signs of MS?

A

Frequency/urgency followed by defecation
Constipation, urgency of defecation
Erectile dysfunction/ejaculatory failure

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10
Q

What is the pattern of cognitive impairment in MS?

A

Develops late in disease

IQ/language affected

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11
Q

What is the pattern of neurological deficit in MS?

A

Appear irregularly throughout CNS in terms of site/time
Come on over days/weeks plateau, gradually resolve over wks/months
Recurrence unpredictable

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12
Q

What is Uthoff’s phenomenon?

A

The fact that sx are worse during a fever/hot weather/after exercise
Central conduction slowed by increased body temperature

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13
Q

What are the different clinical patterns of MS?

A

Primary progressive MS (10-20%)
Relapsing/remitting MS (80-90%)
Fulminating MS (<10%)

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14
Q

Describe primary progressive MS

A

No clear cut relapses/remissions

Diagnosed if progressive deterioration over >1 yr

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15
Q

Describe relapsing/remitting MS

A

Initial episodes resolve completely
Subsequent episodes result in residual disability
Pts eventually develop 2o progressive MS
-steady progression w/o remission

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16
Q

Describe fulminating MS

A

Debilitating progressive deterioration from early stage

17
Q

What is required for a diagnosis of MS?

A

Two characteristic episodes of neurological dysfunction, separated in space/time
MRI evidence of lesions

18
Q

What investigations are appropriate in suspected MS?

A

Bloods - FBC, U&Es, LFT, ESR, TFTs, glucose, ca, B12, HIV serology
MRI - multiple plaques (>10 in clinical relapse)
CSF - cell count raised, high protein, oligoclonal IgG bands (electrophoresis)
VER - delayed occipital EEG reactions to visual stimuli

19
Q

What are the differential diagnoses of MS?

A 
Relapsing-remitting
   -TIAs
   -SLE
   -CNS sarcoidosis
Primary progressive
   -MND
   -CNS mass
   -Spinal/cerebellar degenerative diseases (PD, AD, Huntingtons)
20
Q

What is the management for an acute MS relapse?

A

Investigate to rule out alternative causes
Consider admission
High dose corticosteroids
-Oral methylprednisolone (0.5g/day for 5/7)
-Start ASAP, may reduce severity
Pt education

21
Q

What is the general management for MS?

A 
Annual review by MS MDT
Lifestyle advice (exercise/smoking cessation)
Treat co-existing illness
Manage complications
Disease-modifying therapy
22
Q

What disease-modifying therapy is available in MS?

A

Beta interferon

  • used if
  • relapsing remitting disease with 2 relapses in past year and can walk 100m unaided
  • secondary progressive with 2 relapses in past year and can walk 10m

Glatiramer acetate
Natalizumab

23
Q

What are the common complications of MS?

A 
Fatigue
Spasticity
Ataxia/tremor
Mobility issues
Depression
Bladder dysfunction
Sexual dysfunction
Pressure sores
24
Q

How are the complications of MS managed?

A

Fatigue - Amantadine + cognitive approaches
Spasticity - Baclofen + physiotherapy
Ataxia/Mobility/Pressure Sores - Physio/OT
Depression - CBT
Bladder dysfunction - Oxybutinin OR self-catheterisation
Sexual dysfunction - Sildenafil

25
Q

What is the prognosis of MS?

A

Life-expectancy 20-30yrs
Long latent period (15-30yrs) from an episode of optic neuritis
Prognosis better if sensory onset

26
Q

What are poor prognostic factors for MS?

A

Increased age of presentation
Early cerebellar involvement
Loss of mental functions

Neurology (17 decks)

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