Multiple Sclerosis Flashcards
Multiple Sclerosis
define
most common immune mediated inflammatory demyelingating disease of the CNS
Multiple Sclerosis
epidemology
gender, age, genetics, environmental
- female gender
- age of onset: 28-31
- genetic susceptibility
- environmental
Multiple Sclerosis
characteristic feature on imaging
- presence of focal demyelinated plaques in CNS (optic nerve, spinal cord, brainstem, cerebellum, juxtacortical/periventricular white matter)
Multiple Sclerosis
dx
2
- clinical dx
- get good PMHx, PE, MRI
Multiple Sclerosis
clinical manifestations
2
- monosymptomatic: single lesion
- polysymptomatic: > 1 lesion
Multiple Sclerosis
sensory sx
5
- numbness/tingling
- tightness (“MS hugs”)
- coldness
- swelling of lumbs/trunk
- intense pruritis (unilateral, cervical dermatomes)
Multiple Sclerosis
Neurologic Sx
5
cognitive impairment
* difficulty w/ attention
* short term memory
* speed of information processing
* abstract conceptualization
- Frank Dementia
Multiple Sclerosis
sx of unilateral optic neuritis
- painful monocular vision loss (visual blurring, partial vision loss)
- 90% will recover their vision w/in 2-6 mo
Multiple Sclerosis
pain sx
4
- paroxysmal (sudden) pain
- persistent pain (burning, cold dyesthesias)
- musculoskeletal
- soft tissue
Multiple Sclerosis
descrive uhthoff phenomenon
3 components
- heat sensitivity
- small increases in body temp will worsen sx temporarily
- due to conduction block in central pathways as temp increases
Multiple Sclerosis
GU Sx
5 components
- urge incontinence
- overactive bladder
- functional bladder outlet obstruction
- Urination: hesitancy, interrputed stream, incomplete emptying
- Sexual: ED, decreased libido
Multiple Sclerosis
GI sx
4
- urge incontinence
- constipation
- poor evacuation
- incontinence
Multiple Sclerosis
Neurologic PE Findings
6 components
- Paraplegia/Paraparesis: lesions in the descending tract of the spinal cord
- Spasticity: tonic (resistance to movement) or phasic (involuntary jerks and spasms)
- lhermitte sign
- coordination problems (dysmetria, hypotonia)
- gait disturbances
- cerebellar dysarthria
Multiple Sclerosis
why might pts have diminished DTRs
lesions interrupting the reflex arc
Multiple Sclerosis
what is lhermitte sign
electric shock shooting down the spine or into the limbs (most often after flexion of the neck)
Multiple Sclerosis
sensory PE findings
- vibtration/joint position sense impairment
- patchy areas of reduced pain and light touch perception in limbs/trunk
- Brown-Sequard Syndrome
Multiple Sclerosis
describe Brown-Sequard Syndrome
2
- testing sensation w/ sharp object, feeling is increased or spreads like ripple effect
- contralateral weakness
Multiple Sclerosis
Ocular PE Findings
4 components
- optic neuritis (afferent pupillary defect w/ swinging flashlight test)
- disc edema if head of optic nerve is involved
- internuclear ophthalmoplegia
- pendular nystagmus
Multiple Sclerosis
what is seen on brain MRI
3 components
- hyperintense white matter lesions
- plaques (ring enhancing, ovoid)
- black hole lesions (severe demyelination and axonal loss)
Multiple Sclerosis
what would MRI spine show
5 components
- if here, pt is less likely to be asx
- size > 3mm but < 2mm
- occupy only part of SC
- little to no cord swelling
- focal: clearly delineated, well-circumscribed
Multiple Sclerosis
Spinal MRI describe chronic lesions
2
- smaller
- well-defined margins
Multiple Sclerosis
Spinal MRI describe acute lesions
3 components
- larger
- ill defined
- more gadolinium uptake (dissipates over a few wks)
Multiple Sclerosis
when to do LP
if atypical clinical features, imaging features, or in an atypical population (kids or adults)
Multiple Sclerosis
describe evoked potentials
- electrical events generated in the CNS by peipheral stimulation of a sensory organ
- detects subclinical abnormal CNS function
- define anatomic site of lesion not easily visualized by imaging