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Y2 Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What age group is affected by MS?

A

young people

>20yrs

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2
Q

how severe is MS?

A

MS symptoms vary a lot due to different amounts of demyelination

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3
Q

what is the prognosis of MS?

A

uncertain since the symptoms are so variable

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4
Q

where abouts in the body is the infection of MS?

A

CNS

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5
Q

is the grey or white matter affected during MS?

A

white matter

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6
Q

what is the outcome for most MS patients ?

A

most develop progressive disability

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7
Q

what mechanism causes the demyelination of MS?

A

Activated T cells cross blood brain barrier

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8
Q

is MS an autoimmune disease?

A

yes

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9
Q

is MS chronic or acute inflammation?

A

acute inflammation

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10
Q

what is post inflammatory gliosis ?

A

hypertrophy of glial cells

- this can result in functional damage

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11
Q

what is seen on an MRI scan for a MS patient?

A

white lesions or plaques in the white matter

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12
Q

during MS does axonal loss occur early or late

A

thought to start late but can be variable which is what gives variability to MS

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13
Q

what is seen on the MRI is there is axonal loss ?

A

cerebral atrophy

- black holes

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14
Q

what type of MRI is used best for axonal loss/old inflammation?

A

T1

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15
Q

what type of MRI is used best for demyelination?

A

T2

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16
Q

what is the prevalence in scotland per 100,000?

A

190

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17
Q

on average how many MS patients will a GP have?

A

2-4 patients

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18
Q

how many new cases of MS are there per year in aberdeen?

A

50-60

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19
Q

is MS more common in males or females?

A

females

2-3:1

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20
Q

what gender are autoimmune disease more common in?

A

females

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21
Q

where abouts in the world is MS seen most?

A

north and south of the equator

- the incidence even increases the more north you go in the UK being the highest in the shetland islands

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22
Q

how long will the onset of symptoms be for MS?

A

over a few days

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23
Q

do MS patients recover fully after a relapse?

A

some patients can but for most patients permanent damage is done

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24
Q

what areas of the body can a relapse of MS occur?

A

optic neuritis
brain stem
spinal cord

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25
Q

what symptoms can a MS patient have during a relapse ?

A 
sensory symptoms 
- numbness 
limb weakness 
- ataxia 
vision loss 
- diplopia 
vertigo
bladder problems
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26
Q

what colour is the optic disc during optic atrophy?

A

optic disc looks paler

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27
Q

what are the symptoms with optic neuritis ?

A

pain on moving the eye

everything looks greyer

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28
Q

what are the differential diagnoses for optic neuritis ?

A 
Neuromyelitis optica
Sarcoidosis
Ischaemic optic neuropathy
Toxic/ drugs/ B12 deficiency
Wegeners granulomatosis
Local compression
Lebers hereditary optic neuropathy
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29
Q

if a MS relapse occurs in the brain stem what symptoms would be experienced ?

A

vertigo
nystagmus
ataxia
cranial nerve involvement

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30
Q

what are the criteria for MS diagnosis ?

A

episodes of demyelination at different times (within months or years) and in different area of the body

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31
Q

what are the four types of MS?

A
  1. Relapsing-Remitting MS (RRMS) - 85%
  2. Primary-Progressive MS
  3. Secondary-Progressive MS
  4. Progressive-Relapsing MS
32
Q

what is the progressive phase of MS ?

A

symptoms get worse and won’t go away

- accumulation of symptoms

33
Q

what does the examination of MS depend on?

A

the severity of the MS and the area where MS has occurred

34
Q

what examination can be done for MS patients ?

A
  • afferent pupillary defect
  • nystagmus
  • cerebellar signs (balance, coordination)
  • sensory signs (numbness)
  • weakness
  • spasticity
  • hyperreflexia
  • plantars extensor
35
Q

what criteria has to be met on MRI for MS diagnosis to be made?

A

McDonald criteria

36
Q

what criteria has to be met on clinical signs for MS diagnosis to be made?

A

posers criteria

37
Q

approximately how many lesions are there for each relapse of MS does a patient need to have?

A

10 lesions for each relapse

38
Q

what colour is the CSF in a T2 MRI?

A

white

- the white matter is darker than the grey matter

39
Q

is the white matter lighter than the grey matter with a T1 MRI ?

A

yes

40
Q

what are some risk factors for demyelination?

A

age
smoking
diabetes
HT

41
Q

why would a chest X ray be done while investigating MS?

A

to check for sarcoidosis

42
Q

what investigations can be done for MS?

A

MRI scan

This would only be done if the MRI was atypical:
Lumbar puncture 
Bloods 
CXR 
Eye tests
43
Q

Describe the Relapsing Remitting MS ?

A
  1. demyelination results in relapse
  2. patient recovers
  3. the following relapse results in a the patient not recovering fully
  4. therefore there is a gradual decline in function after each relapse
44
Q

Describe the Secondary Progressive MS ?

A
  1. demyelination results in permanent damage
  2. the second relapse results is even more less recovery
  3. following relapses results in disability and the patient doesn’t get better
45
Q

Describe the Primary Progressive MS ?

A
  1. patient never has a relapse

2. the symptoms just get worse and worse

46
Q

what is sensory MS ?

A

patient only has mild symptoms

47
Q

what percentage of people are affected by sensory MS?

A

5-10%

48
Q

is it common for patients with relapse remitting MS to develop Secondary progressive MS?

A

yes
25% by 10yrs
50% by 20yrs
75% by 35yrs

49
Q

what percentage of MS patients will need a wheel chair?

A

25%

50
Q

what are the good prognostic indicators for MS?

A
  • female
  • presenting with optic neuritis
  • long intervals between releases
  • few relapses in first 5yrs
51
Q

what are the bad prognostic indicators for MS?

A
  • male
  • older
  • multifocal symptoms
  • motor symptoms
52
Q

what effects can MS have on life ?

A 
work 
family 
pregnancy 
sexual function 
bladder and bowel function
53
Q

what age range is primary progressive MS most common?

A

50-60yrs

54
Q

what is the prognosis for primary progressive MS?

A

poor

55
Q

what gender is most effected by primary progressive MS?

A

equal males and females

56
Q

what is the name of Neuromyelitis Optica Disorder

A

Devic’s Disease

57
Q

what is Neuromyelitis Optica Disorder?

A

commonly affects the optic nerves and spinal cord, which can lead to:

  • optic neuritis
  • transverse myelitis
58
Q

Is Neuromyelitis Optica Disorder an autoimmune disease ?

A

yes

59
Q

what antibody may be present in the blood which could diagnose Neuromyelitis Optica Disorder?

A

aquaporin-4 antibodies

60
Q

what is the treatment for Neuromyelitis Optica Disorder?

A

immunosuppression
general health and diet
symptomatic treatment

61
Q

what is the 1st line treatment for MS?

A

Injections

Oral treatments

  • Teriflunomide
  • Dimethyl Fumarate
62
Q

what effect do the injections used 1st line for MS have on the progression of MS?

A

no effect

- not a cure

63
Q

what are the side effects of the 1st line injections for MS?

A
  • flu like symptoms
  • reaction at injection site
  • abnormal blood count and LFTs
64
Q

what drug is used 2nd line given monthly for MS?

A

natalizumab

65
Q

what 2nd line drug can give cardiac problems for MS/

A

fingolimod tablets

66
Q

what 5 day aggressive treatment can be given for MS ?

A

alemtuzumub

67
Q

what are the side effects of alemtuzumub ?

A

high risk thyroid and kidney problems

68
Q

what is a serious side effect of immunosuppression?

A

Progressive Multifocal Leukencephalopathy (PML)

69
Q

what causes Progressive Multifocal Leukencephalopathy (PML)?

A

JC-virus

70
Q

what three immunosuppression drugs can cause Progressive Multifocal Leukencephalopathy (PML)?

A

Natalizumab
Dimethyl fumarate
Fingolimod

71
Q

what can commonly trigger a relapse of MS?

A

having an infection such a cold

- therefore treating the underlying injection could help the relapse

72
Q

do releases increase or decrease during pregnancy ?

A

decrease

73
Q

what symptoms can be treated during a relapse of MS?

A
  1. spasticity
  2. dysaesthesia
  3. urinary
  4. constipation
  5. sexual dysfunction
  6. fatigue
  7. depression
  8. cognitive
  9. tremor
  10. vision
  11. speech/swallowing
74
Q

is MS just treated by one person ?

A

no

- a multi disciplinary team is involved

75
Q

state some people involved in the MDT

A 
MS nurse
Physiotherapy
Occupational therapy
Speech and language therapy (SALT)
Dietician
Rehabilitation specialists
Continence advisor
Psychology/psychiatry
76
Q

what is the cause of MS?

A

unknown

77
Q

does everyone with MS present in the same way?

A

no

- MS is very variable

Y2 Neurology (52 decks)

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