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The Nervous System: Pathology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What demographic does Multiple sclerosis affect

A

Relatively common neurological disease of young people

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2
Q

Where exactly does multiple sclerosis occur

A

In the central nervous system white matter

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3
Q

What is the pathology if multiple sclerosis

A

auto-immune process as activated T cells cross blood brain barrier causing demyelination

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4
Q

What can occur in the repair and recovery of an attack of demyelination

A

Gliosis - reactive change of glial cells, involving the proliferation and hypertrophy of glial cells in the CNS

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5
Q

What can progressive multiple sclerosis pathologically lead to

A

Lead to axonal loss and cerebral atrophy

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6
Q

What is the affect of progressive multiple sclerosis

A

Development of persistent disability - affecting daintily living

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7
Q

Who has a worse prognosis men or woman

A

Men

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8
Q

What is the pathogenies of MS

A

Complex genetic inheritance (F:M 2-3:1)

Commoner in colder temperate climate

(Age of exposure to colder climates affects chances of MS development)

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9
Q

What is the initial presentation of MS

A

Gradual onset over days
stabilises day to weeks
Gradual resolution to complete or partial recovery

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10
Q

For multiple sclerosis to be diagnosed after initial presentation, what needs to occur

A

A Relapse to occur within months or years of first presentation

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11
Q

What is the statistic of MS cases relapses

A

80% cases MS presents with a relapse

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12
Q

How are not all MS relapses the same

A

All have variable site and severity

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13
Q

What are the variable symptoms than can occur with MS relapse

A

Optic neuritis,

Ophthalmoplegia (paralysis of eye muscle)

Limb weakness

Vertigo, diplopia.
Ataxia,
Nystagmus,

Sensory symptoms,

Sphincter disturbance (bladder and bowel involvement)

Sexual disfunction

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14
Q

What are the sensory symptoms experienced in MS

A

Hyperasethesia - excess physical sensitivity

Sensation of

Burning, Tingling, Pins and needles, Crawling, Numbness, Prickling, Sensitive skin, Wetness

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15
Q

What is the initial to lateral presentation of optic neuritis

A

Swelling of optic disc
to
Optic atrophy

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16
Q

What is the symptoms and signs experienced in optic neuritis

A

Symptoms:
Subacute visual loss
Pain on moving eye
Colour vision disturbed

Signs:
relative afferent pupillary defect

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17
Q

How is limb weakness caused in MS

A

Due to MS causing a lesion to upper motor neurone

Weakness occurs below level of lesion

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18
Q

What is bilateral symptoms experienced if MS myelitis - inflammation of the spinal cord

A

Paresis - muscle weakness

Loss of sensation

Reflex changes

Autonomic dysfunction (eg, bowel, bladder, and erectile dysfunction; loss of sweating)

Painful

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19
Q

What is affected in a brainstem relapse due to MS

A

Pons - cranial nerves

Cerebellum

Upper motor neurones

Sensory involvement

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20
Q

What causes progressive phase of MS

A

Accumulation of symptoms and signs

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21
Q

What is the symptoms experienced in Progressive phase MS

A

Fatigue,

temperature sensitivity

Sensory

Stiffness or spasms

Balance,
slurred speech

Swallowing

Bladder & bowel

Diplopia/ oscillopsia - visual disturbance/visual loss

Cognitive-dementia/ emotional lability

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22
Q

What is the definition of MS used for diagnosis

A

Episode of demyelination disseminated in space and time

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23
Q

What is the two diagnostic criteria for MS

A

Posers criteria - clinical examination

Macdonalds criteria - MRI based diagnosis

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24
Q

What is potentially found on examination of MS

A

Afferent pupillary defect

Nystagmus or abnormal eye movements

Cerebellar signs

Sensory signs

Weakness

Spasticity

Hyperreflexia

Plantars extensor

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25
Q

What is found on examination in MS is dependant on

A

Where demyelination has occurred and stage of disease

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26
Q

What can be seen on MRI scan that shows areas of demyelination

A

lesions or plaques

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27
Q

What is the lesions or relapse ratio for a MS patient

A

For 10 lesions a patient experiences 1 relapse

28
Q

What does black hole on an MRI scan indicate

A

Cerebral atrophy

29
Q

What are further investigations for MS

A

Lumbar puncture

Visual/somatosensory evoked response

Blood tests - exclude other inflammatory conditions

Chest X ray

30
Q

What is found in a Lumbar puncture of a MS patient

A

Oligoclonal bands (Immunoglobins) appear in CSF and not serum - shows a CNS disease

31
Q

What is a differential diagnosis of myelitis symptoms

A

Inflammation

  • Devics
  • Sarcoidosis

Infection

Tumour

Paraneoplastic process

Stoke

32
Q

What is the different types of MS

A

Relapse remitting

Secondary progressive

Primary progressive

Sensory

Malignant

33
Q

What occurs in relapsing remitting MS

A

MS patient has episodes of new or worsening symptoms, known as “relapses”. These typically worsen over a few days, last for days to weeks to months, then slowly improve over a similar time period

34
Q

What are periods between relapse attacks called

A

remission

35
Q

What occurs in secondary progressive MS

A

symptoms gradually worsen over time without obvious attacks.

36
Q

What do relapsing remitting MS usualy go on to develop

A

secondary progressive MS within 15- 20 years

37
Q

What occurs in primary progressive MS

A

symptoms gradually worsen and accumulate over several years, and there are no periods of remission

38
Q

When would primary progressive MS present, and what is the prognosis

A

In 5th and 6th decade

Poor prognosis

39
Q

What symptoms does primary progressive usually involve

A

Spinal and bladder

40
Q

What is the affect of sensory MS

A

Little impairment, and few relapses

41
Q

What symptoms and relapse pattern usually indicate for a good prognostic

A

Optic neuritis

Long internal between 1st and 2nd relapse

few relapse in first 5 years

42
Q

What symptoms usually indicate for a bad prognostic

A

Multifocal symptoms and signs

Motor symptoms and signs

43
Q

What is devics disease

A

heterogeneous condition consisting of the simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis)

44
Q

How is Devics disease detected

A

Aquaporin-4 antibodies

Antibody negative in some cases

45
Q

How is MS managed

A

Disease modifying treatment

Relapse treatment

Symptomatic treatment

General health and diet

Multidisciplinary approach

46
Q

Who are the potential (8) profession used in the Multidisciplinary treatment of MS

A 
MS nurse
Physiotherapy
Occupational therapy
Speech and language therapy
Dietician
Rehabilitation specialists
Continence advisor
Psychology/psychiatry
47
Q

What is the symptomatic treatment of spasticity in MS

A

Muscle relaxants
Antispasmodics
Physiotherapists

48
Q

How is sensory involvement: hyperaesthesia treated in MS

A

Amitriptyline

Gabapentin

49
Q

How is bladder and bowel symptoms of MS treated

A

Anticholingeric
Bladder stimulation
Catherisation

Laxatives

50
Q

What is the medical treatment of an acute relapse

A

Oral prednisolone

51
Q

What should always take place with high rise steroids

A

urinary dipstick

52
Q

What is the further management in an acute relapse

A

look for underlying infection

Exclude worsening of usual symptoms with intercurrent illness

Rehabilitation

Vaccination - prevent further relapse

53
Q

Disease modifying treatment is not a cure, but what is its benefit

A

Reduces frequency and severity of relapse

54
Q

What is the 1st line treatments that are subcutaneously or intramuscular injections

A

Beta Interferons

Glatiramer acetate

55
Q

What is the 1st line treatments that are oral

A

Terifunomide

Di-methy fumarate

56
Q

What is the overall side effects of 1st line treatments

A

Injection site reaction

Flu like symptoms

abnormalities of blood count and liver function

57
Q

What is the reduced relapse rate of 1st line treatment of MS

A

reduced relapse rate 1/3

58
Q

What is the three 2nd line treaments of MS

A

Natalizumab (month infusions)

Fingolimod tablets

Alemtuzumub

59
Q

What is the reduced relapse rate of 2nd line treatment of MS

A

reduced replace rate 2/3

60
Q

What is the side affect of Fingolimod tablets

A

bradycardia

61
Q

What is the side affect Alemtuzumub

A

Autoimmune thyroid disease

Immune thrombocytopenic purpura

Good pastures

62
Q

What is the overall affect of disease modifying mediation

A

Causes immunosuppression of the body

63
Q

What treatment of MS can cause Progressive Multifocal Leukencephalopathy (PML)

A

natalizuab, finglomod (2nd line)

dimethyl fumarate (1st line)

as

64
Q

What is Progressive Multifocal Leukencephalopathy (PML)

A

Rare viral disease of the brain caused by the JV virus affecting a weakened immune system (due to MS treatment)
causing progressive damage/inflammation of the white matter of the brain at multiple locations

65
Q

How is the progression of PML monitored on MS treatment

A

MRI annual

JC antibody blood and urine 6 monthly

The Nervous System: Pathology (25 decks)

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