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ENT, neuro, eyes > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

What is MS

A

Inflammatory demyelination of CNS

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2
Q

Risk factors for MS

A

20-50 yes
3 x more in women
FH
Higher latitudes - vit D exposure?

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3
Q

What are attaacks in MS

A

CNS demyelination develops over days to weeks
At least 24 hours can last weeks to months

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4
Q

What need for MS diagnosis

A

Multiple attacks disseminated in space and time

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5
Q

Common initial presentations in MS

A

Optic neuritis
Transverse myelitis
Brainstem inflammation

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6
Q

Who should be investigated for MS

A

Patinet with 1 or more episodes of inflammatory demyelination

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7
Q

Investigation for MS

A

MRI brain and spinal cord

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8
Q

What see on MRI in MS

A

Dawsons fingers
Periventricular plaques - white close ot ventricels
Lesions of different times and areas

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9
Q

What contrast use in MRI

A

Gadolinium contrast - differntiate between ols and active inflamamtion

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10
Q

What lesionsare enhanced with gadolinium

A

Active lesions

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11
Q

What suggests MS on LP

A

Oligoclonal bands ( not present in serum)
Inflammation and immunoglobulin synthesis

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12
Q

Diagnostic criteria for MS

A

Mcdonald criteria

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13
Q

Mcdonald criteria for MS diagnosis

A
  • If 2 or more attacks and lesions - clinical alone
  • If 2 or more attacks, 1 lesion and dissemination in space on MRI
  • 1 attack, 2 lesions and disseminated in time on MRI
  • 1 attack, 1 lesion and disseminated in space and time
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14
Q

How prove dissemination in time

A

Simultaneous asymptomatic contrast enhancing and non enhancing lesions at any time

OR

new T2 and/or contrast enhancing lesions on follow up MRI irrespective of timing

OR

await a second clinical attack

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15
Q

How prove dissemination in space

A

T2 lesion one or more in at least two MS tyical CNS regions:

  • Periventricular
  • Jaxtacortical
  • Infratentorial
  • Spinal cord
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16
Q

How diagnosie MS with no attacks

A

One year of disease progression and at least 2 out of 3 of
Disseminated in space in brain
Space in spinal cord - 2 or more T2 lesions
Positive CSF

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17
Q

Patterns of MS

A

Relapsing remitting
Primary progressive 4Secondary progressive
Progressive relapsing (steady decline, superimposed attacks)

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18
Q

Primary vs secondary progressive

A

Primary = steady decline without attacks
Secondary - initally relapsing remitting then decline without remission peridos

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19
Q

What virus has been linked to risk for MS

A

EBV

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20
Q

What is relapse in MS

A

Reported symptoms or findings - ms pathology
acute/subacute development
Last longer than 24 hours
absence fever/infection
>30 days clinical stability
Attack, exacerbation and (when it is the first episode) clinically isolated syndrome

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21
Q

What can cause worsening of MS symptoms that isnt a relapse

A

Infection or fever esp UTI
Stress/heart/over exertion
MRI if clincial uncertainty

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22
Q

How treat an MS flare

A

IV or oral prednisolone, methylprednisoloin- high dose steroids
Speed recovery time

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23
Q

Purpose of didease modifying treatments in MS

A

Reduce frequency of relaspese
Reduce progression of neurodisability
Given early when remitting relasping

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24
Q

What disease modifying treatments for MS

A

First line - interferon beta - SC
Fingolimod - oral
Alemtuzumab, nata,ocrelizumab

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25
Q

Which medications are most effective but also most side effects/risk

A

Alemtuzumab etc

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26
Q

What risk is esp in MS patients with strong DMTs

A

Progressive multifocal leukoencephalopathy

27
Q

What is PML

A

Reactiveation of JC virus in CNS -> neuro problems

28
Q

What is uhtoffs phenomenon

A

Worsening of MS symptoms after heat exposure

29
Q

How manage fatigue in MS

A

Cooling, pacing activities, amantaine, CBT, mindfulness

30
Q

How manage mood and cognition in MS

A

CBT, SSRIs, duloxetine
Social suppor, sleep/pain/depression education

31
Q

Treatment for pain in MS

A

CBT
Amitryptilline
Gabapentin
Pregabalin

32
Q

Neurogenic bladder treatment

A

Fluid intake control, regimented rroutine
Oxybutinin
Botox
Intermittent self catheterisation

33
Q

Constipation treatment MS

A
  • Good diet+fluid, regular laxatives, bowel care, assisted evacuation, good hygeine
34
Q

Symptoms of neurogenic bladder

A

Urinary frequncy, urgency, nocutria, frequent UTIs

35
Q

First line investigation for urinary incontinence MS

A

US KUB - need to check if any retnetion before treat as determines management plan

36
Q

What is lhermittes symptom

A

Electric shock down bac of spine when neck flexion

37
Q

WHo does MS affect

A

AI disease 40-50 years peakonset
Female 3:1

38
Q

Risk factors for multiple sclerosis

A

EBV - 5x
Smoking
Vit D
Latitiude
Genetics - FH, HLA, IL

39
Q

How does MS behave in pregnancy

A

Experience fewer reapses while pregnant and symptoms improve
1/4 -> relapse in 3 months PP -> corticosteroids

40
Q

First line MS in pregnancy

A

Interferon beta
Glatiramer acetate

41
Q

Can do MRI head in pregnancy for MS?

A

Yes BUT not with gadolinium scan

42
Q

Histopathology of MS nerve cells

A

Multifocal demyelination
Loss of oligodendrocytes
Astrogliosis and loss of axons in mostly white matter

43
Q

Clinical features of MS

A

Visual problems - optic neuritis inital presentaiton
Fatigue
Pain - neuropathic nociceptive, altered sensation
Muscle spasticity, stiff + weak
Mobility problems
Bladder and bowel dysfunction
Sexual dysfunction
Depression and anxiety
Congitive impairment - exec function, learning + short term mem
Speech and swallowing issues

44
Q

Optic neuritis symptoms

A

Tmpeorary vision loss incl scotoma, colour blindness, painful eye movements

45
Q

Optic neuritis on fundoscope

A

Internuclear opthalmoplegia or pale optic disc

46
Q

What pain experienced in MS

A

neuropathic and nociceptive
Trigeminal neuralgia
Optic neuritis
Chest tightness Lhermittes sensation

47
Q

How does spasticitiy and weakness presnet in MS

A

Spasticity in legs > arms
Weakness - both lower limbs>one lower limb>upper
AND lower limb same side>upper limb
Spasms disturb sleep

48
Q

Mobility symptoms MS

A

Demyelination of cerbeallar pathways -> ataxia
Upper limb intention tremor - thalamus and basal anglia involvement

49
Q

Features of bladder and bowel dysfunction

A

Increased frequency and urgency
Urinary retention
Recurrent UTIs
Constipation is the most common bowel complaint

50
Q

What causes speech and swallowing issues MS

A

Bulbar muscle problems -> dysarthria, dysphagia

51
Q

First line blood tests MS

A

FBC
Inflam markers (CNS infections, vasculitides)
LFTs - chronic LD -> neuropathy, HE
U+Es
Calcium
Glucose
TFTs - hypo - fatigue, weak, constipated, slow thought
Vit B12 - SACD
HIV serology

52
Q

Differentials from FBC for MS

A

Anaemia - amcrocytic B12
Malignancy - thrombocytopenia lymphoma

53
Q

Why test calcium when sus MS

A

Can present with paraesthesia and tetany

54
Q

Why do HIV serology when sus MS

A

PML due to reactivation of JCV virus
Lesions occur anywhere in CNS + mimc MS

55
Q

When is LP recommended for MS

A

Insufficient clinical of MRI evidence to diagnose MS
Any presentation other than CIS
Atypical clinical, imaging or lab findings of MS
MS in atypical demographic

56
Q

Neuromyelitis optica vs optic neuritis

A

NO = + for anti aquaporin antibody +/or +ve ant myelin oligodendrocyte glycoprotien

57
Q

Transverse myelitis vs MS

A

Upper motor neurone signs (hyperreflexia, Babinski sign and spasticity)
T2 + Gd lesions in spinal cord but NOT brain
Increased WCC LP

58
Q

Indications for DMARDs MS

A

Relapsing remitting disease + 2 relapses past 2 years + able walk 100m unaided
OR
secondary progressive disease + 2 relapses in past 2 years + walk 10m aided or unaided

59
Q

What drug use for faituge

A

Amantadine

60
Q

First line for spasticity

A

Baclofen and gabapentin
2nd - diaxepam, dantrolene, tizanidine

61
Q

Bladder dysfunction how treat if significant residual volume vs if none

A

Intermittent self catheterisation if residual colume
If no signif residual volume -> anticholinergics eg oxybutinin

62
Q

Complications of MS

A

Recurrent UTIs
Osteopenia, osteoprosis
Depression
Visual impairment
Cognitive impairment
Impaired mobility

63
Q

Progosis

A

Less frequent initial relapses esp if years between first two = better prognosis

ENT, neuro, eyes (34 decks)

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