Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

Multiple sclerosis is chronic T cell-mediated autoimmune, inflammatory disorder characterised by demyelination in the central nervous system (dissemination in space and time)

Question 2

Aetiology behind MS

Answer 2

Environmental factors : EBV and HHV-6
Genetic: XX (female) and HLA-DR2
Vitamin D deficiency

Question 3

Pathology seen in MS

Answer 3

Plaques, 2-10 mm in posterior column and lateral corticospinal column

Question 4

Subtypes of MS

Answer 4

relapsing-remitting
Secondary progressive
Primary progressive

Question 5

Clinical presentation of MS

Answer 5

Visual
optic neuritis: common presenting feature
optic atrophy
Uhthoff’s phenomenon: worsening of vision following rise in body temperature
Bilateral internuclear ophthalmoplegia (medial nucleus Fasiculus is damaged)

Sensory (pins/needles, numbness, trigeminal neuralgia)
Lhermitte’s syndrome: paraesthesiae ( electric shock like symptom down neck and back) in limbs on neck flexion

Motor: (spastic weakness: most commonly seen in the legs)

Cerebellar: ataxia (more often seen during an acute relapse than as a presenting symptom) Intention tremor

Others
urinary incontinence
sexual dysfunction
intellectual deterioration

Question 6

1st line investigation for MS

Answer 6

MRI of brain and spinal cord to show dissemination in space and time

Question 7

MRI features for MS

Answer 7

Dawson’s fingers (Sagittal T2 flair)
Acute enhancement “bright” lesion (Sagittal T1 + contrast)
Hyper intense ‘bright lesion” (axial T2 flair)

Question 8

CSF features for MS

Answer 8

oligoclonal bands (and not in serum)
increased intrathecal synthesis of IgG