Multiple Sclerosis Flashcards
Outline the process and features of MS
A relatively common neurological disease affecting primarily young people. The presentation and severity is variable, prognosis is uncertain
Disease affects the white matter of the CNS, demyelinating axons causing focal disturbance of function-relapse. Most patients develop progressive disability
Describe the process of demyelination
Auto immune - activated T cells cross blood brain barrier causing demyelination, acute inflammation of the myelin sheath and loss of function
What can be seen on the brain MRIs of patients with MS?
White lesions/plaques
What features are seen on MRI in patients with advanced MS?
Black holes that are later seen as cerebral atrophy
What are the general demographics of MS?
20s-30s affected
Females more than males
Less common in Asia
Describe the initial presentation of patients with MS
80% percent present with a relapse - an attack of demyelination
Gradual onset over days that stabilises after days/weeks
What symptoms can characterise an MS relapse?
Optic neuritis Sensory symptoms Limb weakness Diplopia/Vertigo/Ataxia - Brainstem Spinal cord - bilateral symptoms and bladder signs
What is the one line definition of MS?
Episodes of demyelination disseminated in space and time
Describe optic/retrobulbar neuritis
Subactue visual loss Painful on movement Colour vision disturbed Initial swelling oft he optic disk Optic atrophy seen later Relative afferent pupillary defect
What are some differential diagnoses for optic neuritis?
Neuromyelitis optica Sarcoidosis Ischaemic B12 deficiency Wegners Herpes simplex
What happens in the progressive phase of MS?
An accumulation of symptoms and signs that include Fatigue, temp sensitivity Sensory signs Stiffness or spasms Balance, slurred speech Swallowing Bladder & bowel Visual defect Cognitive defect - dementia/emotional lability
What are some signs that can be found on examination of a patient with MS?
Afferent pupillary defect Nystagmus/abnormal movements Cerebellar signs Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor
What is necessary for diagnosis of MS?
Evidence of demyelination separated in time and space
What is the name of the clinical criteria for diagnosis of MS?
Posers
What is the name of the MRI criteria for diagnosis of MS?
Macdonald
