Multiple sclerosis Flashcards

1
Q

List the 3 different types of multiple sclerosis

A
  1. relapsing remitting
  2. secondary progressive
  3. primary progressive (if severe, called fulminant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What metabolic disturbances may cause MS-like symptoms

A
  • thyroid problems
  • B12 deficiency

Thus always do blood tests to exclude the above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Explain how MS is activated by the immune system

A
  1. viral infx (EBV) causes autoimmune reaction to occur
  2. inflammation in blood vessels around CNS white matter causes breach of BBB
  3. activated immune cells enter CNS through BBB
  4. immune cells attack and destroy myelin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain with reference to oligodendrocytes, why there is a relapsing remitting pattern in early stages of MS

A

Remaining oligodendrocytes remyelinate areas destroyed by immune cells.

(Note: new oligodendrocytes are NOT made)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which is the main immune cells that causes the problems in MS

A

T lymphocytes

attack the oligodendrocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is considered an MS attack

A

Any sign of increased inflammatory activity within the CNS that leasts >24h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common type of MS

A

relapsing remitting

which then develops to secondary progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which type of MS presents later in life

A

Primary progressive (symptoms tend to present in late 40s/early 50s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Optic neuritis symptoms in MS

A
  • desaturation of colour

- smeary blurry vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Transverse myelitis symptoms in MS

A
  • UMN weakness below level of attack
  • Numbness with sensory levels
  • Bowel & bladder disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Brainstem damage symptoms in MS

A
  • Double vision
  • Facial palsy
  • Facial numbness
  • Vertigo
  • Dysarthria
  • Ataxia
  • Tremor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Paroxysmal (spasmic) symptoms in MS

A
  • Lhermitte’s phenomenon (electrical shock sensation when putting chin on chest)
  • Trigeminal neuralgia
  • Tonic spasms
  • Epilepsy
  • Uthoff’s phenomen (heat sensitivity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Lhermitte’s phenomenon?

A

electrical shock sensation when putting chin on chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Uthoff’s phenomen?

A

Heat sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what sort of MS patients should steroids be given

A

Patients presenting with recent symptoms (within the last week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Limitations of steroid treatment for MS

A
  • Not effective for slowly accumulated problems
  • Don’t affect disease progression
  • Don’t affect long term outcome of relapse
17
Q

What other autoimmune condition commonly presents similarly to MS

A

Myasthenia gravis

18
Q

What is often the first symptom to present in Myasthenia gravis patients?

How to differentiate from MS?

A

Ptosis and diplopia

Differentiating MG from MS:
Muscles are easily fatiguable. Limbs will start out normally but fatigue quickly on exertion. Eyes are first to be affected as eye muscles used most often.

19
Q

What class of drugs is used to treat acute relapses of MS

A

High dose corticosteroids

20
Q

Where does positive Lhermitte’s sign indicate where the plaques in MS are?

A

Cervical spinal cord