Multiple Sclerosis

Question 1

What is multiple sclerosis?

Answer 1

a chronic and progressive autoimmune condition involving demyelination in the central nervous system

Question 2

Does MS affect the central or peripheral nervous system?

Answer 2

Central

Question 3

Is MS more common in men or women?

Answer 3

Women x3

Question 4

What cells provide myelin to the CNS?

Answer 4

Oligodendrocytes

Question 5

What cells provide myelin to the PNS?

Answer 5

Schwann cells

Question 6

Describe the pathophysiology of multiple sclerosis: (2)

Answer 6

1) the immune system attacks the myelinated sheath of CNS myelinated neurons
2) the immune cell infiltration affects electrical signals moving across the neurons

Question 7

True or false: re-myelination can occur in the early stages of MS

Answer 7

True

Question 8

What phrase is used to describe the varying lesion patterns of MS?

Answer 8

disseminated in time and space

Question 9

Give 5 potential causes of MS:

Answer 9

1) genetics
2) Epstein-Barr virus
3) low vitamin D
4) smoking
5) obesity

Question 10

What is the most common presentation associated with multiple sclerosis?

Answer 10

optic neuritis

Question 11

What is optic neuritis?

Answer 11

demyelination of the optic nerve, presenting with unilateral reduced vision developing over hours to days

Question 12

Give 4 clinical findings associated with optic neuritis:

Answer 12

1) central scotoma
2) pain with eye movement
3) impaired colour vision
4) relative afferent pupillary defect

Question 13

What is a central scotoma?

Answer 13

a large central blind spot

Question 14

What is a relative afferent pupillary defect?

Answer 14

where the pupil in the affected eye constricts more when shining a light in the contralateral eye than when shining in the affected eye

Question 15

What drug class is used to treat optic neuritis?

Answer 15

Steroids

Question 16

Give 5 eye movement abnormalities associated with optic neuritis:

Answer 16

1) diplopia
2) nystagmus
3) oscillopsia
4) internuclear ophthlamoplegia
5) conjugate lateral gaze disorder

Question 17

Eye movement abnormalities indicate lesions in which nerves? (3)

Answer 17

1) oculomotor nerve
2) trochlear nerve
3) abducens nerve

Question 18

What is oscillopsia?

Answer 18

the visual sensation of the environment moving and being unable to create a stable image

Question 19

How does internuclear ophthalmoplegia present? (2)

Answer 19

1) impaired adduction in the ipsilateral eye
2) nystagmus

Question 20

A lesion to which structure causes internuclear ophthalmoplegia?

Answer 20

medial longitudinal fasciculus

Question 21

Explain why a lesion to the medial longitudinal fasciculus causes eye movement abnormalities:

Answer 21

the medial longitudinal fasciculus connects the cranial nerve nuclei of CN III, IV and VI which allows coordination of eye movement

Question 22

How does conjugate lateral gaze disorder present?

Answer 22

1) both eyes drift laterally
2) when looking laterally in the direction of the affected eye, the affected eye will not be able to adduct

Question 23

Conjugate lateral gaze disorder indicates an MS lesion to which nerve?

Answer 23

abducens nerve

Question 24

Give 8 general neurological symptoms that may be seen in MS:

Answer 24

1) incontinence
2) Horner syndrome
3) facial nerve palsy
4) limb paralysis
5) trigeminal neuralgia
6) numbness
7) paraesthesia
8) Lhermitte’s sign

Question 25

What is Lhermitte’s sign?

Answer 25

an electrical shock sensation that travels down the spine and into the limbs when flexing the neck

Question 26

What lesion does Lhermitte’s sign indicate?

Answer 26

dorsal column lesion in the cervical spinal cord

Question 27

What is sensory ataxia?

Answer 27

a loss of proprioception often caused by a lesion in the dorsal columns

Question 28

Give two presentations associated with sensory ataxia:

Answer 28

1) Romberg’s test
2) pseudoathetosis

Question 29

What is pseudoathetosis?

Answer 29

abnormal writhing movements

Question 30

What is meant by the term clinically isolated syndrome in MS?

Answer 30

the first episode of demyelination and neurological sypmtoms

Question 31

What is relapsing-remitting MS?

Answer 31

episodes of disease followed by recovery (the most common presentation when diagnosed)

Question 32

What is primary progressive MS?

Answer 32

worsening disease and neurological symptoms without relapsing and remissions

Question 33

What is secondary progressive MS?

Answer 33

where there is relapsing and remitting disease but there is progressive worsening of symptoms with incomplete remissions

Question 34

What two investigations may be used to help diagnose MS?

Answer 34

1) MRI to identify demyelination lesions
2) lumbar puncture to detect oligoclonal bands in CSF

Question 35

What two drugs can be given to reduce spasticity in MS?

Answer 35

1) Baclofen
2) Gabapentin

Question 36

What two drugs can be given to reduce oscillopia in MS?

Answer 36

1) Gabapentin
2) Memantine

Question 37

What drug class is used to treat relapses of MS?

Answer 37

Steroids