multiple sclerosis Flashcards
what is multiple sclerosis?
a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged
how does demyelination occur in MS?
activated T cells cross the blood brain barrier causing demyelination
what would you expect to see on an MRI of a patient with MS?
lesions or plaques
what is a “black hole”
area on an MRI where brain tissue has been lost as a result of inflammation in an MS plaque
how do most MS cases present?
with a relapse
an attack of demyelination or inflammation
what does the onset of MS present as?
gradual onset over days
what symptoms can present in an MS relapse?
optic neuritis sensory symptoms limb weakness diplopia vertigo ataxia can be bilateral spinal cord symptoms
what are some features of optic neuritis?
subacute visual loss
pain on moving eye
colour vision disturbed
initial swelling of optic disc
what MRI criteria is used to diagnose MS?
macdonald criteria
what investigations are used to diagnose MS?
MRI
CXR
bloods to exclude other inflammatory conditions
what are the different types of MS?
relapsing remitting secondary progressive primary progressive sensory malignant
what are some poor prognostic indicators for MS?
male
older age
multifocal symptoms and signs
motor symptoms and signs
what are some features of primary progressive MS?
no relapses
often presents in 5th and 6th decade
spinal symptoms
bladder symptoms
what are some features of devics disease?
optic neuritis
myelitis
aquaporin 4 antibodies
antibody negative in some cases
what are 1st line disease modifying MS treatments?
beta interferons/glatiramer acetate
