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Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what does relapsing remitting mean?

A

there are episodes of symptoms

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2
Q

why does demyelination occur in MS?

A

> autoimmune process
activated T cells cross blood brain barrier causing acute inflammation of the myelin sheath
leads to demyelination

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3
Q

what is post inflammatory gliosis?

A

functional deficit after attack

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4
Q

what appears on an mri in MS?

A

> pale patches or lesions

> black holes later on

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5
Q

what are the black holes seen on MRI?

A

cerebral atrophy

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6
Q

what is the prevalence of MS in Scotland?

A

190 per 100000

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7
Q

how are affected more males or females?

A

females

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8
Q

what climate is MS commoner in?

A

temperate climate

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9
Q

what sort of condition is MS associated with?

A

autoimmune disease

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10
Q

what do most MS cases present with?

A

> relapse (an attack of inflammation)
gradual onset
stabilises in days to weeks with gradual resolution

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11
Q

describe relapse symptoms

A 
> optic neuritis
> sensory symptoms
> limb weakness
> vertigo
> ataxia
> diplopia
> bladder problems
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12
Q

describe optic neuritis

A 
> sub-acute visual loss (and colour vision)
> pain on eye movement
> initial swelling of optic disc
> optic atrophy seen later
> afferent pupillary defect
> resolves over a couple of weeks
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13
Q

what is the differential for optic neuritis?

A 
> MS
> neuromyelitis optica
> sarcoidosis
> ischaemic optic neuropathy
> B12 deficiency
> wegeners granulomatosis
> local compression
> lebers hereditary
> infection
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14
Q

what can occur in a relapse involving the pons?

A

internuclear opthalmoplegia

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15
Q

what can occur in relapse involving the cerebellum?

A

> vertigo
nystagmus
ataxia

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16
Q

describe myelitis

A 
> can be partial or transverse
>sensory level often with band of hyperaesthesia (excessive skin sensitivity)
> weakness (upper motor neuron changes)
> bladder and bowel involvement
> painful (sometimes)
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17
Q

what is the differential diagnosis for myelitis?

A 
> inflammation (Devics, SLE, sarcoidosis)
> infection (post)
> tumour
> paraneoplastic process
> stroke
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18
Q

would an isolated incident of demyelination be enough to diagnose MS?

A

no, episodes of demyelination disseminated in space and time

19
Q

describe the progressive phase

A 
there is an accumulation of symptoms and signs including: fatigue
stiffness
balance issues
bladder issues
vision issues
cognitive issues
20
Q

what will examination findings depend on?

A

where demyelination has occurred and the stage of the disease

21
Q

what eye signs might you see on examination of someone with MS?

A

> afferent pupillary defect
nystagmus
abnormal eye movements

22
Q

what might you see in a limb examination of someone with MS?

A

> weakness
spasticity
hyper-reflexia
plantar extension

23
Q

how would you diagnose MS?

A

> evidence of demyelination separated by time and space
poser criteria (clinical)
macdonald criteria (MRI)

24
Q

for 10 lesions a patient may experience how many relapses (approximately)?

A

one

25
Q

what other examination could you carry out depending on the clinical picture?

A

> lumbar puncture
visual/somatosensory evoked response
bloods (excludes other inflammatory conditions)
chest x ray

26
Q

what would you look at in a lumbar puncture?

A

if oligoclonal bands were present in the CSF but not in the serum

27
Q

what does the differential diagnosis depend on?

A

the symptoms and signs and whether the first relapse or progressive disease

28
Q

name some types of MS

A 
> relapsing remitting
> secondary progressive
> primary progressive
> sensory 
> malignant
29
Q

describe secondary progressive

A

after a relapsing remitting form of disease there is a steady increase in impairment

30
Q

what number of people with MS will require a wheelchair?

A

1 in 4

31
Q

what are indicators of a good prognosis?

A

> female
present with optic neuritis
long interval between 1st and 2nd relapse
few relapses in the 1st 5 years

32
Q

what are bad prognostic indicators?

A

> male
older
multifocal symptoms and signs
motor symptoms and signs

33
Q

describe primary progressive MS

A

there is a steady increase in impairment over time with no relapses and a poor prognosis.
often presents in the 5th or 6th decade.

34
Q

describe devics disease(neuromyelitis optica spectrum disorder)

A

> inflammatory disorder of the CNS
optic neuritis
myelitis
involving aquaporin-4antibodies

35
Q

what is the treatment for devics disease?

A 
> health and diet
> relapse treatment
> symptomatic treatment
> multi-disciplinary approach
> disease modifying treatment
36
Q

what is the management for an acute relapse of devics disease?

A

> look for underlying infection
oral prednisolone
rehabilitation
symptomatic treatment

37
Q

what is the effect of pregnancy on relapse in devics disease?

A

there are fewer relapses during pregnancy but increased risk in the first 3 months post partum

38
Q

what are the first line disease modifying treatments for devics disease?

A

> beta interferons
glatiramer acetate
teriflunomide
dimethyl fumerate

39
Q

what are the side effects of first line disease modifying treatment in devics disease?

A

> flu like symptoms
injection site reactions
abnormalities of blood count and liver functions

40
Q

what are the effects of first line disease modifying treatments in devics disease?

A

> reduced relapse rate by 1/3

> no effect of disability progression

41
Q

what are second line agents in devics disease?

A

> natalizumab (monthly infusion)
fingolimod tablets
alemtuzumub

42
Q

what is progressive multifocal leukencephalopathy caused by?

A

jc-virus

43
Q

what is the management for multifactorial leukencephalopathy?

A

> immunosuppression (natalizumab, dimethyl fumarate, fingolimod)
annual MRI
JC antibody and urine 6monthly
symptomatic treatment

Nervous System (45 decks)

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