Multiple sclerosis

Question 1

What is it?

Answer 1

Autoimmune condition involving demyelination in CNS
Immune system attacks the myelin sheath of the myelinated neurones

Question 2

Who does it tend to affect?

Answer 2

young adults
women>men

Question 3

What is the characteristic feature?

Answer 3

Lesions vary in location
Lesions are disseminated in time and space

Question 4

Which cells are affected?

Answer 4

Oligodendrocytes

Question 5

What are potential causes?

Answer 5

Multiple genes
EBV
Low vitamin D
Smoking
Obesity

Question 6

What is the most common presentation?

Answer 6

Optic neuritis

Question 7

What are key features of optic neuritis?

Answer 7

Central scotoma - enlarged central blind spot
Pain on eye movement
Impaired colour vision
Relative afferent pupillary defect

Question 8

What is a relative afferent pupillary defect?

Answer 8

Pupil of affected eye constricts more when shining a light in the contralateral eye than when shining in the affected eye
When testing the direct pupillary reflex, reduced pupil response to shining light in the eye affected by optic neuritis

Question 9

What nerve lesions cause diplopia and nystagmus?

Answer 9

Oculomotor (CN 3)
Trochlear (CN 4)
Abducens (CN 6)

Question 10

What nerve lesion causes a conjugate lateral gaze disorder?

Answer 10

Abducens CN 6

Question 11

What is Lhermitte’s sign? Where does it indicate the disease is?

Answer 11

Electric shock travelling down the spine and limbs when flexing the neck
Indicates disease in cervical spinal cord in dorsal column

Question 12

What is transverse myelitis?

Answer 12

Inflammation in the spinal cord

Question 13

What focal weakness symptoms can MS present with?

Answer 13

Incontinence
Horners syndrome
facial nerve palsy
limb paralysis

Question 14

What focal sensory symptoms can MS present with

Answer 14

Trigeminal neuralgia
numbness
paraesthesia
Lhermittes sign

Question 15

What types of ataxia can it present wit?

Answer 15

Sensory
Cerebellar

Question 16

What test would be positive with sensory ataxia? what else may you see

Answer 16

Rombergs test positive - losing balance when standing with eyes closed
Due to loss of proprioception
Pseudoathetosis - involuntary writhing movements

Question 17

What is clinically isolated syndrome

Answer 17

First episode of demyelination and neuro signs and symptoms
May never have another episode or may go on to develop MS

Question 18

Describe secondary progressive MS

Answer 18

Relapsing remitting disease but progressive worsening of symptoms with incomplete remissions
Symptoms become increasingly permanent

Question 19

What is primary progressive MS

Answer 19

Worsening disease and sx without relapses and remission

Question 20

What investigations support diagnosis

Answer 20

MRI - lesions
Lumbar puncture - detects oligoclonal bands in the CSF

Question 21

How can relapses be treated?

Answer 21

Steroids
IV or PO

Question 22

What is long term treatment?

Answer 22

Disease modifying therapies

Question 23

how can fatigue be managed

Answer 23

Amantadine
Modafinil
SSRIs

Question 24

How can urge incontinence be managed?

Answer 24

Antimuscarinics e.g. solifenacin

Question 25

How can spasticity be managed?

Answer 25

baclofen
gabapentin

Question 26

How can oscillopsia be managed?

Answer 26

Gabapentin
Memantine

Question 27

What is oscillopsia

Answer 27

Visual sensation of the environment moving and being unable to create a stable image