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Year 2 C&M symposia > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Inflammation in CNS&raquo_space; loss of myelination and slowing of nerve conductance.

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2
Q

What is likely to the be the cause of:

  • pupil not constricting with light
  • next day no vision
  • delayed cortical response
  • normal fundoscopy?
A

Optic neuritis.

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3
Q

What is optic neuritis?

A

Inflammation of the optic nerve.

-causes pain and loss of vision

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4
Q

What proportion of patients with optic neuritis go on to develop MS?

A

50%.

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5
Q

What is likely to be the cause of:

  • tingly numbness starting in feet and ascending to chest
  • unsteady walking and fatigued easily
  • electric shock sensations when head bent?
A

Transverse myelitis.

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6
Q

What is transverse myelitis?

A

Inflammation inside the spinal cord.

-often targets myelin

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7
Q

What is Lhermitte’s phenomenon?

A

Electrical sensation running down back and into limbs.

-often induced by bending head forwards

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8
Q

What proportion of patients with transverse myelitis go on to develop MS?

A

50%.

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9
Q

What is the diagnosis if a patient suffers from optic neuritis and transverse myelitis at different times (1+ years apart)?

A

Multiple sclerosis.

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10
Q

What is the diagnosis if a patient suffers from optic neuritis and transverse myelitis at the same time?

A

Not definitely MS.

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11
Q

What investigations can be done to diagnose MS?

A
  • MRI
  • serum
  • CSF analysis
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12
Q

How common is MS?

A

The most common cause of neurological disability in younf adults (UK).

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13
Q

What is the peak age of onset of MS?

A

30-40 years.

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14
Q

What is the sex ratio for MS?

A

More common in females - 2:1.

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15
Q

Which ethnicities have a higher risk of developing MS?

A

-Northern Europeans
-US caucasians
-Canadians
(Further North of equator)

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16
Q

What is often low in patients who develop MS?

A

Vitamin D levels.

-not sure why

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17
Q

What drives the inflammation in the CNS?

A

CD4+ T lymphocytes.
-produce antibodies that activate the complement system
»attack myelin

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18
Q

Give examples of treatments currently used.

A
  • Interferon beta 1-b and 1-a
  • Glatiramer acetate
  • Teriflunamide
  • Flingolimod
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19
Q

Why is interferon beta used to treat MS?

A

Reduces the number of relapses by a third.

-effective in early disease, not necessarily long term

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20
Q

What drug is commonly used to treat MS?

A

Methylprednisolone.

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21
Q

What is tysabri (natalizumab)?

A

1st humanised monoclonal antibody approved for MS treatment.

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22
Q

How does tysabri work?

A

Inhibits adhesion molecules on surface of immune cells and prevents migration to brain.
-attaches to a4-integrin

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23
Q

What do monoclonal antibodies end in?

A
  • mab.

e. g. infliximab

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24
Q

What are new oral therapies for MS? (3)

A
  • Fingolimod
  • Teriflunomide
  • Dimethyl fumarate
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25
Q

How does fingolimod work?

A

Internalises S1P1 receptors&raquo_space; blocks lymphocyte exit from nodes.
-lymphocytes don’t&raquo_space; CNS

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26
Q

How are patients who suffer at least 2 relapses in 2 years treated if JC virus -ve?

A

Tysabri (1-2 years), then fingolimod.

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27
Q

How are patients who suffer at least 2 relapses in 2 years treated if JC virus +ve?

A

Straight onto fingolimod.

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28
Q

What is JC virus?

A

John Cunnigham virus.

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29
Q

What can JC virus cause in MS patients?

A

Progressive multifocal leukoencephalopathy (PML).

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30
Q

How is aggressive MS treated (3-4 relapses)?

A

Alemtuzumab (chemotherapy).

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31
Q

What are the types of progression of MS? (4)

A
  • Relapsing-remitting MS
  • 1* progressive MS
  • 2* progressive MS
  • Progressive relapsing MS
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32
Q

How do most patients present?

A

Most present with relapsing-remitting MS (85%).

-develops to progressive

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33
Q

What is the consequence of presenting with 1* progressive MS?

A

Faster progression than relapsing-remitting MS.

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34
Q

What does an MRI scan of a patient with relapsing-remitting MS show?

A

Increased brain lesions.

-over years

35
Q

What does an MRI scan of a patient with progressive MS show?

A

Brain atrophy.

-over years

36
Q

What is spastic paraparesis?

A

Disorder leading to progressive stiffness and contraction in lower limbs.
-suggests spinal cord problem

37
Q

What proportion of MS patients are confined to a wheelchair within 10 years?

A

15%.

38
Q

What are symptoms of progressive MS?

A
  • Tremour and spasticity
  • Fatigue
  • Mood problems
  • Pain and sensory problems
  • Genitosphincteral problems
39
Q

What are potential targets for neuroprotective therapy?

A
  • Inflammatory mechanisms
  • Genetically determined (e.g. degeneration)
  • Demyelination
  • Growth factor depletion
40
Q

What type of disorder is MS?

A

Autoimmune.

41
Q

Is MS curable?

A

No, but it is treatable.

42
Q

What is the most common progression of MS?

A

Relapsing phase followed by progressive phase.

43
Q

What is a spinal cord injury?

A

Disruption to spinal cord&raquo_space; change in motor, sensory or autonomic function.

44
Q

Is the spinal cord often cut in half when injured?

A

No, very rarely.

-normally inflammatory cascade&raquo_space; damage

45
Q

What are upper motor neurons?

A

Motor neurons originating from the motor region of the brain, brainstem, cerebellum and spinal cord.

46
Q

What are lower motor neurons?

A

Motor neurons that come off the brainstem of spinal cord.

-i.e. spinal and cranial nerves

47
Q

What sort of lesion is a cauda equina lesion?

A

Lower motor neuron lesion.

-spinal nerves

48
Q

What is the sex ratio of spinal cord injuries?

A

4: 1.

- More common in males

49
Q

What sort of age distribution do spinal cord injuries have?

A

Bimodal distribution.

-peaks in young age and old age

50
Q

What is the prevalence of spinal cord injuries in the UK?

A

40,000.

51
Q

How does the incidence of spinal cord injuries alter across the week? Suggest why.

A

Highest at the weekend (40%).

-alcohol, recreational activities, etc.

52
Q

What are the 2 types of causes of spinal cord injuries?

A

Congenital

Acquired

53
Q

What are the main congenital causes of spinal cord injury? (4)

A
  • Spina bifida
  • Birth trauma
  • Congenital spinal anomaly
  • Spinal muscular atrophy
54
Q

What are the main acquired causes of spinal cord injury? (5)

A
  • Vehicle crashes (trauma)
  • Bacterial abscesses (infection)
  • Inflammation
  • 2* tumour
  • Degeneration
55
Q

How is the level of spinal cord injury examined?

A
  • Dermatomes (light tough, pinprick)

- Myotomes (manual muscle testing)

56
Q

What does a cervical lesion (C1 to T1) cause?

A

Tetraplegia/quadriplegia.

if hand/arm affected

57
Q

What does a thoracic lesion (T2 to L5) cause?

A

Paraplegia.

58
Q

What scale is used to grade spinal cord injury?

A

AISA impairment scale.

A&raquo_space; D

59
Q

What does A on the AISA impairment scale mean?

A

COMPLETE - No motor or sensory function is preserved in S5.

-faecal incontinence

60
Q

What does D on the AISA impairment scale mean?

A

INCOMPLETE - Motor function preserved and at least half of key muscles below the neurological level have a muscle grade of 3+.

61
Q

What does muscle grade 3 indicate?

A

Full range of movement against gravity.

-can normally walk again

62
Q

What are the 2 categories of spinal pathways?

A
  • Descending motor tracts

- Ascending motor tracts

63
Q

What are the 2 types of descending motor tracts?

A
  • Lateral corticospinal

- Anterior corticospinal

64
Q

What are the 3 types of ascending motor tracts?

A
  • Dorsal column
  • Anterolateral spinothalamic
  • Spinocerebellar
65
Q

Where do descending motor tracts begin?

A

In the motor cortex.

66
Q

What are the clinical types of spinal cord lesion? (4)

A
  • Anterior cord
  • Posterior cord
  • Central cord
  • Brown-sequard syndrome
67
Q

What typically causes anterior cord lesions?

A

Vascular lesions.

-blood enters cord anteriorly

68
Q

Who are central cord lesions more common in?

A

Elderly.

69
Q

What is Brown-Sequard syndrome?

A

A lesion in spinal cord&raquo_space; weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

70
Q

What is the prognosis for mobility if A on the AISA scale?

A

1%.

71
Q

What is the prognosis for mobility if D on the AISA scale?

A

100%.

72
Q

What proportion of

A

88%.

73
Q

What proportion of 65-80 yr olds who suffer from a spinal cord injury reach there adjusted life expectancy?

A

50%.

74
Q

What is the average life expectancy of >80 yr olds who suffer from a spinal cord injury?

A

2.5 years.

75
Q

What are common injuries associated with spinal cord injuries? (4)

A
  • Limb (20%)
  • Chest (19%)
  • Head (12%)
  • Abdominal (3%)
76
Q

What can lesions above T6 and spinal shock lead to?

A

Excessive vagal stimulation.

77
Q

What does excessive vagal stimulation cause?

A
  • Bradycardia

- Asystole

78
Q

How is excessive vagal stimulation avoided?

A
  • Atropine prior to intubation

- Suctioning

79
Q

What can cause autonomic dysreflexia?

A

Lesions above T6.

80
Q

How does autonomic dysreflexia present?

A
  • Headache
  • Hypertension
  • Facial flushing
81
Q

What are acute complications of spinal cord injuries? (3)

A
  • UTIs (e.g. stones)
  • Respiratory infection
  • Pressure sores (e.g. osteomyelitis)
82
Q

What are the chronic complications of spinal cord injuries? (2)

A
  • Progressive neurological decline (e.g. syringomyelia)

- Rheumatological complications (e.g. hetertopic ossification)

83
Q

How are spinal cord injury complications managed?

A
  • Bed rest
  • Skin care
  • Bladder care
  • Prevent thromboembolic complications.

Year 2 C&M symposia (11 decks)

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