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Z Year3 Neuro Conditions > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the definition of MS?

A

demyelinating central nervous system condition clinical defined by two episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in space and time

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2
Q

What sort of reaction is happening in MS?

A

Type IV hypersensitivity reaction

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3
Q

What is the pathophysiology of MS?

A
  1. Oligodendrocyte produce myelin that surround axon
  2. Oligodendrocytes get attacked so not myelin to protect axon
  3. Remyelination occurs in early MS but stops eventually
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4
Q

Why are shwan cells not affected?

A

shwan cell in PNS and oligodendrocytes in CNS and MS affects CNS mainly

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5
Q

What are common RF for MS?

A
  1. FHx
  2. Female
  3. Northern latitude
  4. Genes encoding for HLA-DR2
  5. Vit D defic
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6
Q

What is the classic epid in MS?

A
  1. White women

2. Between 20-40years

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7
Q

What are common symptoms and signs in MS?

A
  1. Visual disturbance in one eye
  2. Peculiar sensory phenomena (e.g. Lhermitte’s sign)
  3. Pain on eye movement
  4. Fatigue
  5. Leg cramping
  6. Urinary frequency
  7. Bowel dysfunction
  8. Spasticity/increased muscle tone
  9. Imbalance/incoordination
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8
Q

What is Charcot’s neurological triad?

A
  1. Dysarthria
  2. Intention tremor
  3. Nystagmus
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9
Q

Why is there such a range of symptoms in MS?

A

plaques can affect sensory, motor and autonomic system hence range of symptoms

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10
Q

What are possible DDx for MS?

A
  1. Myelopathy due to cervical spondylosis
  2. Fibromyalgia
  3. Sleep disorders
  4. Sjorgen syndrome
  5. Vit B12 deficiency
  6. Ischaemic stroke
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11
Q

What investigations would you do in MS?

A
  1. MRI brain
  2. MRI spinal cord
  3. CSF
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12
Q

What bloods do you do in MS?

A
  1. FBC
  2. Comprehensive metabolic panel
  3. TSH
  4. Vitamin B12
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13
Q

What would MRI brain show in MS?

A

hyperintensities in periventricular white mater

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14
Q

What would MRI spinal cord show in MS?

A
  1. demyelinating lesions in the spinal cord, particularly the cervical spinal cord
  2. detection of alternate diagnosis, such as cervical spondylosis
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15
Q

What would CSF show in MS?

A
  1. IgG oligoclonal bands on electrophoresis with 95% of MS patient
  2. can have high level of antibodies in CSF (shows autoimmune process)
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16
Q

What is the acute treatment of MS?

A
  • 1st line: methylprednisolone: 1000mg IV once daily 3 days

- Sometimes w plasma exchange

17
Q

What is the ongoing treatment for MS?

A

1st line: immunomodulators: e.g. interferon beta 1a

18
Q

What is the ongoing treatment for secondary progressive MS?

A

1st line: Siponimod or methylprednisolone

2nd line: cladribine

19
Q

What treatment can be used for relapsing midl/moderate MS?

A

Dimethyl-fumarate

20
Q

What other medication can be used for relapsing remitting disease of MS?

A

monoclonal antibodies alemtuzumab and natalizumab

21
Q

When else do you prescribe medication for MS?

A

for treating complications

22
Q

What complications of MS may be need to be prescribed for?

A
  1. Fatigue
  2. Spasticity e.g. baclofen or gabapentin
  3. Ataxia and tremor
  4. Mental health
  5. Bladder problems
23
Q

What are possible complications of MS?

A
  1. UTI
  2. Osteopenia and osteoporosis
  3. Depression
  4. Visual impairment
  5. Erectile dysfunction
  6. Cognitive impairment
  7. Impaired mobility
24
Q

What criteria is used for MS?

A

McDonald criteria used

25
Q

What is the prognosis of MS?

A

> 80% patients develop progressive disability

26
Q

What are different types of MS?

A
  1. Relapsing remitting disease
  2. Secondary progressive
  3. Primary progressive
  4. Progressive relapsing
27
Q

What happens during MS?

A

chronic inflammatory multifocal, demyelinating disease of the central nervous system of unknown cause, resulting in loss of myelin, and oligodendroglial and axonal pathology

28
Q

What HLA is associated with MS?

A

HLA DLRB1*15c

29
Q

What is Lehermitte’s sign?

A

electric shock down back triggered by neck flexion

30
Q

What are 3 different types of MS and how common are they?

A
  1. Relapsing-remitting (RR) MS: 80-85%
  2. Secondary progressive (SP) MS follows RR MS after 10-15 years
  3. Primary progressive (PP) MS 15-10%
31
Q

What is key to diagnosis in MS?

A
  1. Absence of alternative diagnosis
  2. Dissemination in time (DIT)
  3. Dissemination in space (DIS)
32
Q

How can you tell which lesions are old and which are new in MS?

A

Gadolinium contrast can show which lesion new and which old (lights up active lesion esp in in acute attack – anything that lights up is at most 6 weeks old)

33
Q

What other test can be done in MS?

A

Electrophysiology (VEPs)

Z Year3 Neuro Conditions (34 decks)

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