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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

A cell-mediated autoimmune disorder characterised by demyelination in the CNS

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2
Q

Who is MS most common in?

A

MS is 3 times more common in women

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3
Q

When does MS typically present?

A

In people under 50

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4
Q

What are the three sub-types of MS?

A

Primary progressive
Secondary progressive
Relapsing-remitting

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5
Q

What is the most common subtype of MS?

A

Relapsing-remitting

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6
Q

What is the pathophysiology of MS?

A

The myelin sheath of oligodendrocytes becomes inflamed, and is infiltrated by immune cells

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7
Q

What are some risk factors for developing MS?

A

Genetics
EBV
Low vitamin D
Smoking
Obesity

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8
Q

What is the most common initial presentation of MS?

A

Optic neuritis

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9
Q

What is relapsing-remitting MS?

A

Periods of neurological disease and illness followed by recovery.

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10
Q

What is primary progressive MS?

A

MS that progressively worsens, without relapsing and remitting episodes

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11
Q

What is secondary progressive MS?

A

Progressive worsening of the disease with relapses that have incomplete remissions

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12
Q

What is required for a diagnosis of MS?

A

Lesions disseminated in space and time

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13
Q

What investigations can be carried out to confirm MS?

A

Contrast MRI
Lumbar puncture

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14
Q

What would be seen on MRI?

A

Periventricular white matter lesions

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15
Q

What would be found on lumbar puncture in the CSF?

A

Oligoclonal bands
Mildly raised protein
Lymphocytes

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16
Q

What is the first line management of an MS relapse?

A

1g IV methylprednisolone for 3 days

17
Q

What is the second line management of an MS relapse?

A

Plasma exchange

18
Q

What is the long term treatment of MS?

A

Disease modifying therapies
- Natalizumab
- Interferon beta
- Glatiramer
- Dimethyl fumarate
- Diroximel fumarate

19
Q

What are the symptoms of MS?

A

Fatigue
Difficulty walking
Vision problems
Numbness
Tingling
Muscle spasms
Muscle stiffness
Weakness

20
Q

What factors are associated with a worse prognosis in MS?

A

Male
Motor signs at onset
Early relapses
Many MRI lesions
Axonal loss

21
Q

Why is a contrast MRI performed to diagnose MS?

A

You can age the different lesions on a contrast MRI (to see lesions disseminated in space and time)

22
Q

What contrast is used in a contrast MRI scan?

A

Gadolinium

23
Q

What medication is first line for muscle spasticity in MS?

A

Baclofen
Gabapentin

24
Q

What are the symptoms of optic neuritis?

A

Unilateral decrease in visual acuity over hours to days
Central scotoma
Pain worse on eye movement
Relative afferent pupillary defect
Poor discrimination of colours

25
Q

What are the other causes of optic neuritis?

A

Sarcoidosis
SLE
Syphilis
Measles
Mumps
Neuromyelitis optica
Lyme disease

26
Q

What is the management of optic neuritis?

A

High dose steroids

Neurology (35 decks)

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