Multiple sclerosis Flashcards
What is multiple sclerosis?
An autoimmune demyelinating disorder of the central nervous system
What is Charcot’s triad for MS?
Nystagmus
Intention tremor
Scanning speech
What demographic of people is generally most affected by MS?
Younger women (20-50yo) of Northern European descent. The risk increases with distance from the equator (possibly due to Vitamin D levels)
What are the suspected environmental triggers for MS?
Viral exposures (EBV, canine distember virus)
Tobacco exposure
**CMV, HSV and HIV may be protective
Describe the pathogenesis of MS
APCs present a signal that activates autoreactive T cells, which target the CNS. T cells attach to and cross the BBB, release ILs that disrupt the BBB, proinflammatory cytokines destroy myelin and cause neuronal death. These degenerative changes prevent neuronal signaling from properly occurring.
Describe the pattern of MS symptoms over time
Characterized by clinical relapses due to cycles of CNS demyelination followed by remission. The frequency varies but is 1-2 relapses per year for the early stages of disease.
Describe the symptoms of optic neuritis
Common syndrome associated with MS
Decreased monocular vision painful eye movement, decreased R/G color vision, afferent pupillary defect and heat intolerance
What brainstem syndromes are suggestive of MS?
Internuclear opthalmoplegia Oculomotor dysfunction Ataxia Trigeminal neuralgia Facial nerve palsy CST/UMN involvement
What are the silent symptoms of MS?
Fatigue, bladder dysfunciton, sexual dysfunciton, spasticity, pain, cognitive impairment, bowel dysfunction
What are the major diagnostic criteria for MS?
Separation in space and time.
2 separate affected parts of the CNS
2 or more episodes of symptoms
Confirmed radiologically
What are Dawson’s fingers?
Diagnostic T2MRI with WM lesions radiating out perpendicular from the lateral ventricals within the corpus callosum
What is neuromyelitis optica?
A condition that mimics MS on presentation
Longitudinally extensive spinal cord lesion with bilateral optic neuritis, hiccups, normal/minimal brain lesions
More aggressive than MS
What is acute disseminated encephalomyelitis?
A post-infectious monophasic illness that presents with headache, vomiting, drowsiness and meningism. MRI shows large fluffy multifocal lesions. More common in children.
Similar to GBS, but in the brain instead of periphery
What is progressive multifocal leukoencephalopathy?
Illness caused by opportunistic infection of JC virus, commonly seen in HIV patients. Multiple lesions are seen on T2/FLAIR. Can lead to death or serious neurologic injury.
Describe the treatment regimen for MS relapses
Goal: speed recovery and limit injury
High dose steroids are used to limit effects of acute relapses
Other options: ACTH, plasmaphoresis, IVIG
