Multiple Sclerosis (2) Flashcards
What is this?
Who does it typically present in?
What is characteristic of it?
How is it classified?
➊ Chronic, progressive condition characterised by plaques of demyelination and eventual axonal loss in the CNS
➋ Women around 20-50 yrs
➌ • Clinical attack of MS e.g. optic neuritis
• Disseminated in Time and Space
➍ • Relapsing-Remitting (80%)
• Primary Progressive - disease gets worse from beginning
• Secondary Progressive - disease starts off as relapsing-remitting before becoming worse
N.B. Myelin cells are called Oligodendrocytes in the CNS and Schwann cells in the PNS
What are its most common presenting features?
What are some of its other features?
How does internuclear opthalmoplegia present?
➊ • Optic Neuritis - blurred vision, painful eye movements, and colour blindness (esp. red)
• Patchy parasthaesia - sensory disease
➋ • Internuclear ophthalmoplegia - lesion in MLF of the brainstem
• Ataxia - sensory or cerebellar
• Spastic paraparesis
➌ • Impaired adduction ipsilateral to the lesion
• Nystagmus contralateral to the lesion
N.B. MS is a CNS disease, so the pt shouldn’t present with any LMN signs
Which investigations are done?
How is an acute attack managed?
How is it managed long-term?
➊ * History and examination
* Bloods - FBC (WCC), CRP
* MRI - typically see periventricular white matter lesions
* LP - CSF Oligoclonal bands, which indicates the presence of an auto-immune process in the CNS
N.B. MRI w/contrast is needed for a diagnosis! A plain MRI would be used to look for evidence of demyelination, whilst the contrast (gadolinium) enhances some lesions and not others to demonstrate dissemination in space.
N.B. Important to rule out infection before treating
➋ Methylprednisolone 1g IV
➌ * Disease-modifying therapies e.g. Beta-interferon
* Baclofen and botox for spasticity
* Anticholingerics e.g. Oxybutynin for bladder incontinence
* Gabapentin, Pregabalin for neuropathic pain
N.B. Intermittent self-catherisation can be an option in those with a neuropathoic bladder.
