Multiple sclerosis Flashcards
What is multiple sclerosis a disease of?
CNS white matter
What course do most patients with MS have?
relapsing-remitting (most go on to develop disability)
What is the process of demyelination?
autoimmune T activated cells cross blood brain barrier
What imaging technique can show plaques/lesions for MS?
MRI
Pathogenesis of MS
temperate climate, autoimmune disease, viruses, more common in females in Scotland, vitamin D, genetic inheritance
Symptoms of MS relapse
optic neuritis, ataxia, vertigo, diplopia, nystagmus, sensory symptoms, limb weakness, bladder
optic neuritis symptoms
subacute visual loss in one eye, pain moving eye and colour vision disturbed with initial optic disc swelling and later on atrophy
Pupil reaction to light in optic neuritis
pupil dilates
Some causes of optic neuritis
Ms, toxic, drugs, sarcoidosis, infection, SLE etc
What is myelitis?
inflammation within spinal cord which can be partial or transverse with a band of hyperaesthesia with bladder involvement, may or may not be painful
What must be present with the demyelination to diagnose MS?
must be disseminated in space and time - occurring in different areas of the CNS
Examination involves…
pupillary response, hyperflexia, plantar extensor, weakness, cerebellar signs, spasticity
Other investigations carried out…
CXR to exclude sarcoidosis
Lumbar puncture - oligoclonal bands in CSF but not serum
FBC - exclude other inflammation
List some different types of MS
relapsing remitting, secondary progressive, primary progressive, sensory and malignant
Some good and bad prognostic indicators
good = women, long time between relapses, optic neuritis bad = old, men, multifocal signs
