Multiple Sclerosis Flashcards

1
Q

MS

What is the pathophysiology of it?

A
  • T cells enter the CNS, resulting in acute inflammatory demyelination via type IV hypersensitivity.
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2
Q

MS

What are some typical features of MS?

A
  • optic neuritis
  • diplopia
  • transverse myelitis
  • clumsiness
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3
Q

MS

Tests

A
  • mri
  • lumbar puncture
  • visual evoke potentials
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4
Q

MS

A

McDonald’s criteria

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5
Q

MS

How to manae acutely and as long-term management.

A
  • look for infection and steroids
  • beta-interferon
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6
Q

MS

What is it?

A

idiopathic, immune-mediated demyelinating disease of the central nervous system (CNS), where there is loss of axons in discrete areas, called plaques

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7
Q

MS

What are some risk factors?

A
  • female
  • FHx
  • autoimmune disorders (particularly those with HLA DQ6 variants).
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8
Q

MS

What factors might trigger MS?

A
  • 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
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9
Q

MS

What are the main characteristics of the disease?

A

The main characteristics of this disease are:
* Demyelination
* Acute inflammation around the demyelinated areas
* Plaque formation after incomplete healing

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10
Q

MS

What are 4 main patterns associated with MS?

A
  • relapsing-remitting (85%)
  • secondary progressive
  • primary progressive
  • progressive relapsing
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11
Q

MS

How do pts typically present?

A

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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12
Q

MS

Damage to these areas can cause what signs/symptoms?

  • Motor cortex
  • Frontal lobe
  • Parietal lobe
  • Temporal
  • Optic nerve
  • Cerebellum
  • Brainstem
  • Spinal cord
A

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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13
Q

MS

How is MS diagnosed?

A

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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14
Q

MS

How do we investigate?

A
  • MRI
  • CSF analysis
  • Visual evoked potentials
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15
Q

MS

What might we see in an MRI?

A

– 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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16
Q

MS

What might we see in CSF?

A

– oligoclonal bands of IgG can support the diagnosis

17
Q

MS

What might we see in visual evoked potentials?

A

– shows decreased duration velocity along axons