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Neurology > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

An autoimmune condition characterised by episodes of inflammation of the nervous tissue in the CNS, causing demyelination

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2
Q

Describe the aetiology of MS

A

Females (3:1)
20-40 y/o
More common as you move away from the equator

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3
Q

What are some factors that cause MS?

A

At least 60 genes have been implicated (HLA, MHC, etc.)
Environmental factors (EBV, VitD deficiency)

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4
Q

Describe the pathophysiology of MS

A

T-cell mediated autoimmune response against the white matter of the brain and spinal cord

Plaques of demyelination can occur anywhere but occur most commonly in the optic nerve, brainstem and cervical spinal cord

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5
Q

How does lower urinary tract dysfunction occur in MS?

A

CNS demyelination causes increased tone at the bladder neck as well as detrusor muscle hypersensitivity and sphincteric dyssenergia

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6
Q

What are the 3 main patterns of MS?

A

Relapsing-Remitting MS
Secondary progressive MS
Primary progressive MS

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7
Q

Describe the pattern of relapsing-remitting MS

A

Symptoms occur in attacks (relapses) with a characteristic time course: onset over days and typically recovery, either partial or complete, over weeks

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8
Q

Describe the pattern of secondary progressive MS

A

This late stage of MS consists of gradually worsening disability progressing slowly over years; some 75% of patients with relapsing-remitting MS will eventually evolve into a secondary progressive phase by 35 years after onset

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9
Q

Describe the pattern of primary progressive MS

A

Characterized by gradually worsening disability without relapses or remissions

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10
Q

What are the types of presentations of MS

A

Pyramidal dynsfunction
Optic neuritis
Sensory symptoms
Lower urinary tract dysfunction
Cerebellar dysfunction
Brainstem dysfunction
Internuclear ophthalmoplegia
Fatigue

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11
Q

What are some symptoms of pyramidal dysfunction?

A
  • Increased tone
  • Spasticity
  • Weakness
  • Affects extensors of upper limbs and flexors of lower limbs
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12
Q

What are some symptoms of optic neuritis?

A

Painful visual loss over 1-2 weeks
Blurred vision (Unilateral)
Reduced or lost colour vision
RAPD

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13
Q

What are some sensory symptoms of MS

A
  • Pain
  • Paraesthesia
  • Dorsal column loss - proprioception and vibration
  • Numbness
  • Trigeminal neuralgia
  • Odd sensation on neck flexion (Lhermitte’s sign)
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14
Q

What are some symptoms of lower urinary tract dysfunction?

A
  • Increased frequency and urgency
  • Nocturia
  • Urge incontinence
  • Retention
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15
Q

What are some symptoms of cerebellar dysfunction in MS?

A
  • D - Dysdiadochokinesia
  • A - Ataxia
  • N - Nystagmus
  • I - Intention tremour
  • S - Slurred speech
  • H - Hypotonia
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16
Q

What are some symptoms of brainstem dysfunction in MS?

A
  • Diplopia - CN VI palsy
  • Facial weakness - CN VII palsy
17
Q

What is internuclear ophthalmoplegia?

A

A condition in which there is formation of a demyelinated plaque in the medial longitudinal fasciculus

18
Q

What are some symptoms of internuclear ophthalmoplegia?

A
  • Distortion of binocular vision
  • Failure of adduction - diplopia
  • Nystagmus in abducting eye
  • Lag
19
Q

What are some investigations required in MS?

A

Bloods
Neurophysiology
MRI
Lumbar puncture

20
Q

What bloods are required in MS?

A

Bloods to rule out other causes:
- FBC
- Inflammatory markers
- U&Es
- LFT, TFT
- Glucose
- HIV serology
- Calcium
- B12 levels

21
Q

What will be seen on MRI in MS?

A
  • Periventricular lesions
  • Discrete white matter abnormalities
  • Areas of focal demyelination
  • Active inflammatory plaques can be distinguished from inactive ones by using a contrast agent
22
Q

What will be seen in the CSF on lumbar puncture?

A

Oligoclonal bands

23
Q

How is acute relapse of MS managed in MS

A

Mild - Symptomatic treatment
Moderate - Oral steroids
Severe - Admit/IV steroids

24
Q

How is pyramidal dysfunction managed in MS?

A
  • Physiotherapy
  • Occupational therapy
  • Anti-spasmodic agent e.g. oral baclofen, oral tizanidine, botulinum toxin, intrathecal baclofen
25
Q

How are sensory symptoms managed in MS?

A
  • Anticonvulsant e.g. gabapentin
  • Antidepressant e.g. amitriptyline
  • TENS machine
  • Acupuncture
  • Lignocaine infusion
26
Q

How is lower urinary tract dysfunction managed in MS?

A
  • Bladder drill
  • Anti-cholinergics e.g. oxybutynin
  • Desmopressin
  • Catheterisation
27
Q

How is fatigue managed in MS?

A
  • Amantadine
  • Modafinil if sleepy
  • Hyperbaric oxygen
28
Q

What is first line disease modifying therapy in MS?

A
  • Tecfedira, aubagio
  • Interferon beta
  • Glitiramer acetate
29
Q

What is second line disease modifying therapy in MS?

A
  • Monoclonal antibody - tysabri, ocrevus, lemtrada
    • Anti-CD20, anti-CD 50, Anti-integrin
  • Fingolimod, cladrabine
30
Q

What is third line disease modifying therapy in MS?

A
  • Mitoxantrone
  • HSCT (stem cell transplantation)
31
Q
A

Neurology (28 decks)

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