Multiple Sclerosis Flashcards
State the pathological and clinical definitions of MS [2]
Pathological Definition: Inflammatory disease of the CNS characterised by demyelination and variable degrees of axonal loss and gliosis.
Clinical Definition: Objective CNS dysfunction, i.e. involvement of two or more white matter structures (space) separated by time, with no other aetiology.
Describe gross pathological of MS patients [1]
Increased dark spots of white matter (where myelination has been lost) [1]
Peak age of MS onset is between [] years.
The rate of MS in [males / females] is increasing rapidly while the [female / male] rate of MS has remained stable.
Peak age of MS onset is between 20-40 years.
The rate of MS in females is increasing rapidly while the male rate of MS has remained stable.
Deficiency in which vitamin is associated with MS? [1]
Vitamin D - theres a geographical distribution
Describe the histopathological changes that occur in MS [3]
- Perivenular inflammation
- Demyelination: ingested by macrophages
- Gliosis (axons replaced by scar tissue)
Which viral infection is assocaited with MS? [1]
Infection from Epstein-Barr Virus
(no evidence of infection means have minimal chance of MS)
[] is a risk factor for multiple sclerosis
Smoking is a risk factor for multiple sclerosis
Describe the overall disease progession of MS [2]
Get periods of inflammation
AND
Overall progressive cerebral atrophy: ventricles get larger
What are oligoclonal bands and how are they used in the diagnosis
Oligoclonal bands:
- IgG unique to CSF: indication that there is an immune process being driven in the CNS.
- Very consistent finding for patients with MS
- Take samples from CSF (lumbar puncture) & blood and compare
Describe the genetic link between MS [2]
Over 200 genes associated with MS
The more genetically close you are to a sufferer of MS the higher chance of suffering, but NOT a Mendelian disease
The effect of which genetic region dwarfs that of any other genetic region associated with MS? [1]
HLA
(But still very multi-gene implicated)
Describe the signs and symptoms of MS [8]
Motor - spasticity, weakness and gait abnormalities.
Sensory - positive (pins & needles) and negative sensory phenomena (loss of sensation).
Cerebellum - inco-ordination and unsteady gait.
Brain Stem - diplopia, vertigo, nystagmus, dysarthria
Optic Nerves - optic neuritis (blurred vision)
Bladder and Bowel - incontinence
Higher Functions - depression, poor concentration, forgetfulness, etc.
Fatigue
All patients present differently. Not going to be all of them
Describe the different clinical subtypes of MS [3]
Primary progressive MS:
* Steady increase in disability without attacks
Relapsing-remitting MS
* Unpredicatable attacks which may or maynot leave permanent deficits followed by periods of remission
Secondary progressive MS
* Initial relapsing-remitting MS that suddenly begins to have a decline without periods of remission
Describe the approaches of treatment for MS [2]
Immunomodulatory/immunosuppressant:
* Mainstay of traditional treatment
* dampens down the immune system
Induction therapy
* “Reset” the immune system
* Higher risk (in the short term)
* Long-lasting disease remission off treatment
A 26 year old female, with previous history of myelitis, presents with double vision on looking to the left.
Internuclear ophthalmoplegia
Which symptom is a very common indicator for MS? [1]
Internuclear ophthalmoplegia
Which eye reflex is often severely impacted in MS? [1]
swinging light reflex
State what has occured in this MS patient [1]
BBB broken down
What is the name for this sign of MS on MRI? [1]
Dawsons fingers
The key expression to remember to describe the way MS lesions change location over time is that they are []
The key expression to remember to describe the way MS lesions change location over time is that they are “disseminated in time and space”.
Unilateral lesions in the sixth nerve causes a condition called []
Unilateral lesions in the sixth nerve causes a condition called internuclear ophthalmoplegia.
The internuclear nerve fibres are responsible for coordinating the eye movements to ensure the eyes move together. Ophthalmoplegia means a problem with the muscles around the eye.
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
internuclear ophthalmoplegia: is a disorder of conjugate lateral gaze due to demyelination of the which neural tract? [1]
medial longitudinal fasciculus (MLF).
The medial longitudinal fasciculus (MLF) connects which two CNs? [2]
CN III & VI
