Multiple Sclerosis Flashcards
MS
What is the pathophysiology of it?
- T cells enter the CNS, resulting in acute inflammatory demyelination via type IV hypersensitivity.
MS
What are some typical features of MS?
- optic neuritis
- diplopia
- transverse myelitis
- clumsiness
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Tests
- mri
- lumbar puncture
- visual evoke potentials
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McDonald’s criteria
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How to manae acutely and as long-term management.
- look for infection and steroids
- beta-interferon
MS
What is it?
idiopathic, immune-mediated demyelinating disease of the central nervous system (CNS), where there is loss of axons in discrete areas, called plaques
MS
What are some risk factors?
- female
- FHx
- autoimmune disorders (particularly those with HLA DQ6 variants).
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What factors might trigger MS?
- Low vitamin D levels – making the disease more prevalent in countries that are further north or south of the equator
- EBV or HHV6 infections
- Smoking
MS
What are the main characteristics of the disease?
The main characteristics of this disease are:
* Demyelination
* Acute inflammation around the demyelinated areas
* Plaque formation after incomplete healing
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What are 4 main patterns associated with MS?
- relapsing-remitting (85%)
- secondary progressive
- primary progressive
- progressive relapsing
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How do pts typically present?
recurrent neurological deficits that come and go
- 75% of patients will present with one major deficit (optic neuritis -> most common)
- 25% -> combination
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Damage to these areas can cause what signs/symptoms?
- Motor cortex
- Frontal lobe
- Parietal lobe
- Temporal
- Optic nerve
- Cerebellum
- Brainstem
- Spinal cord
Motor cortex – hypertonia, hyperreflexia
Frontal lobe – mild cognitive issues, disinhibition
Parietal lobe – visuospatial problems
Temporal – poor memory
Optic nerve – optic neuritis, oscillopsia
Cerebellum – cerebellar syndrome
Brainstem – CN III dysfunction, internuclear ophthalmoplegia, bulbar dysfunction
Spinal cord – sensory dysfunction, UMN hemiplegia, autonomic dysfunction, neuropathic pain
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How is MS diagnosed?
Diagnosis of MS should be made with a history of at least 2 relapses + clinical evidence of 2 or more lesions, or evidence of 1 lesion plus a previous history of relapse.
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How do we investigate?
- MRI
- CSF analysis
- Visual evoked potentials
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What might we see in an MRI?
– White matter plaques can show a lesion, especially in the corpus callosum, periventricular regions, brainstem and cerebellum. However, these patches can also be found in healthy patients, so cannot use MRI alone for MS diagnosis.
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What might we see in CSF?
– oligoclonal bands of IgG can support the diagnosis
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What might we see in visual evoked potentials?
– shows decreased duration velocity along axons
