Multiple sclerosis

Question 1

Def

Answer 1

chronic degenerative disease of the CNS characterized by demyelination and axonal degeneration in the brain and spinal cord, which are caused by an immune-mediated inflammatory process

Question 2

Exacerbation

Answer 2

New symptoms or significant worsening of symptoms caused by CNS demyelination that last at least 24 hours and are not accompanied by fever or infection
Pseudorelapse: recurrence or significant worsening of existing symptoms due to stressors (e.g., infection, heat)

Question 3

RIS, CIS

Answer 3

Radiologically isolated syndrome (RIS)
The presence of demyelinating lesions characteristic of MS in an asymptomatic individual

Clinically isolated syndrome (CIS)
A single episode of neurological symptoms resulting from CNS demyelination

Diffuse cerebral sclerosis (Schilder disease) [10][11]
A rare inflammatory demyelinating CNS condition that affects children and young adults
Large areas of demyelination lead to various neurological deficits

Question 4

Types

Answer 4

Relapsing-remitting MS (RR-MS)
Secondary progressive MS (SP-MS)

Primary progressive MS (PP-MS)

Question 5

Symptoms

Answer 5

Optic neuritis
Relative afferent pupillary defect (Marcus Gunn pupil)
Internuclear ophthalmoplegia (INO) as a result of a lesion in the MLF

Demyelination of spinal cord tracts
-Lhermitte sign
-Pyramidal tract lesion (UMN)
-Dorsal spinal column lesion: loss of vibration and fine-touch sensation, numbness, paresthesias, sensory ataxia usually involving the trunk or one or more limbs
Neuropathic pain
Absent abdominal reflex
Cerebellar involvement
Transverse myelitis
Asymmetric paraplegia, unilateral sensory loss, bladder dysfunction
Cranial nerve palsies: diplopia, facial palsy, trigeminal neuralgia
Autonomic dysfunction
Mental changes

Uhthoff phenomenon: a reversible exacerbation of neurological symptoms following an increase in body temperature,

downwards pronator drift in pronator drift test

Question 6

Charcot triad

Answer 6

Charcot neurological triad of scanning speech, nystagmus, and intention tremors

Question 7

Dx

Answer 7

The McDonald Criteria for both DIT and DIS - Dissemination in time and space, must both be met to confirm a diagnosis of MS

Question 8

MRI findings

Answer 8

Multiple sclerotic plaques (most commonly found in the periventricular white matter) with finger-like radial extensions (Dawson fingers) related to demyelination and reactive gliosis
Contrast-enhancement of active lesions;

Question 9

CSF

Answer 9

Oligoclonal bands manifest due to increased production of multiple nonspecific IgG sub-fractions - intrathecal inflammation

Question 10

Tx

Answer 10

Acute - GCs
plasmapheresis
Chronic - IFN B, glatiramer
natalizumab, ocrelizumab, alemtuzumab,