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Neuro > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

define MS

A

Chronic autoimmune T cell mediated inflammatory disorder of the CNS
diagnosis requires two or more attacks affecting different parts of the CNS = dissemination in time and space

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2
Q

what is the commonest cause of chronic non-traumaticneurological disability in young adults?

A

multiple sclerosis

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3
Q

at what age does MS usually begin?

A

20-40 years

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4
Q

what is primary progressive MS?

A

slow, unstoppable decline in neurological function from the outset of the disease

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5
Q

what is secondary chronic progressive MS?

A

slow unstoppable decline in neurological function following a relapsing remitting course

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6
Q

what three major factors influence whether someone gets MS?

A

genetics
environment
chance

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7
Q

what is the geographical distribution of MS?

A

closer to the equator, MS is less common

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8
Q

which ethnic origin is most likely to get MS?

A

white/Caucasian

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9
Q

is MS more common in males or females?

A

females

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10
Q

what is the link between MS and migration?

A

if a sb migrates from a country where MS is not prevalent to one where it is common, their risk of developing MS increases and this is affected by the age of migration (in this case an earlier migration to a country where MS is common will increase the risk)

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11
Q

what is the concordance of MS in monozygotic twins and what does this mean?

A

30%
this figure is lower (~ 5%) in dizygotic twins so there is some genetic influence but not purely genetic as it is not 100%
so need to be genetically susceptible

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12
Q

what components of the immune system are relevant to MS?

A 
T cells 
B cells and the antibodies they make 
macrophages 
complement 
cytokines
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13
Q

Explain the pathology of MS

A

may be triggered by a viral infection, lymphocytes become able to enter the BBB (not normal) and evoke an immune response there - macrophages and antibodies can cause demyelination and damage to axons. Remyelination may occur, but the myelin is thin and axonal damage does not recover
plaques of demyelination form and these can be seen microscopically and on MRI
PNS not affected

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14
Q

what are the features of active lesions in MS?

A 
demyelination 
hypercellular plaque edge due to inflammatory infiltration 
perivenous inflammatory infiltrates 
extensive BBB disruption 
older plaques have central gliosis
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15
Q

what are the features of inactive lesions of MS?

A

demyelination
hypocellular plaque
moderate to minor BBB disruption
plaques are gliosed

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16
Q

what symptoms and signs do spinal cord plaques cause?

A

weakness, paraplegia, spasticity, tingling, numbness
Lhermitte’s sign
bladder and sexual dysfunction

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17
Q

what symptoms do affected optic nerves produce?

A

optic neuritis
eye pain
impaired vision

18
Q

what symptoms and signs does damage to the brainstem cause?

A

dysarthia
double vision
vertigo
nystagmus

19
Q

what symptoms and signs does damage to the cerebellum cause?

A 
dysarthia 
nystagmus 
intention tremor 
ataxia 
think DANISH
20
Q

which parts of the CNS are mainly affected by MS?

A 
optic nerves 
periventricular region 
corpus callosum 
brainstem 
cerebellum 
spinal cord - corticospinal tracts and DCML
21
Q

what are the typical symptoms and signs in MS?

A 
optic neuritis 
spasticity 
pyramydal signs (ie those of a UMN like hyperreflexia, Babinski sign)
sensory symptoms and signs - reduced vibration and proprioception
Lhermitte's sign 
hystagmus 
double vision
vertigo 
bladder and sexual dysfunction 
tiredness 
depression 
loss of coordination
Uhthoff’s phenomenon
22
Q

what is Lhermitte’s sign?

A

electric shock-like sensation that occurs on flexion of the neck. This sensation radiates down the spine, often into the legs, arms, and sometimes to the trunk
tremor
ataxia

23
Q

what is Uhthoff’s phenomenon?

A

temporary worsening of symptoms with increases in body temperature eg after exercise or hot bath

24
Q

what are the common first symptoms of MS?

A 
weakness  
paraesthesiae 
visual loss 
incoordination
vertigo 
sphincter imparment
25
Q

what is vertigo?

A

a feeling that everything is spinning, which can cause loss of balance. It is more than just dizziness

26
Q

what are the four types of MS progression?

A

relapsing remitting MS
primary porgressive MS
secondary progressive MS
progressive/relapsing MS

27
Q

what are the 2 essential criteria for diagnosis MS?

A

two or more CNS lesions disseminated in time and space

exclusion of other conditions

28
Q

what investigations are done for MS?

A

MRI - main one
CSF analysis from LP - look for oligoclonal IgG bands
Evoked potentials
other tests eg blood tests to rule out differential diagnoses

29
Q

what is radiologically isolated syndrome?

A

defined by MRI findings suggestive of multiple sclerosis (MS) in asymptomatic (“clinically silent”) patients.

30
Q

is MRI sensitive?

A

YES! the best investigation there is :)

31
Q

what does it mean if oligoclonal IgG bands are found in MS?

A

the bands are compared to the serum bands and if the bands are not present in the serum sample, then there is inflammation that is confined to the CNS

32
Q

what different types of evoked potentials can be done and what are their advantages?

A
  1. visual
  2. somatosensory
  3. brainstem
    - they are non-invasive
    - can detect clinically silent lesions
    - gives evidence of dissemination in space
    - pinpoints lesions - associated with specific symptoms
    - suitable for any pt
33
Q

what are the disadvantages of evoked potentials?

A
  • they do not give evidence of dissemination of lesions in time
  • they are not sepcific for MS
34
Q

what factors may suggest that MS may not be the diagnosis?

A 
no objective neurological deficits 
no objective dissemination of lesions in time and space 
strongly positive family history 
no eye linvolvement 
localised disase 
no CSF abnormality 
pain is the predominant symptom
progressive on outset in young pts
35
Q

what are the differential diagnosis of MS?

A 
SLE
Sjörgen's syndrome 
lyme disease 
syphilis 
AIDS
36
Q

what drugs are given DURING a severe relapse

A

steroids - they are awesome for acute relapses

37
Q

what are the two main disease modifying drugs that are given for MS to reduce the relapse rate and severity of relapses?

A

interferon beta

glatiramer acetate

38
Q

what are the main adverse effects of betaferon?

A

injection site reactions
flu like symptoms
mild intermittent lyphopenia
rises in liver enzymes

39
Q

what are the associated symptoms that need to be therapeutically managed?

A 
pain 
depresssion
bladder and sexual dysfunction 
spasticity 
fatigue
tremor
impaired mobility
40
Q

how can tremor be treated?

A

beta blockers
barbiturates
gabapentin
carbamazepine

Neuro (9 decks)

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