Multiple sclerosis

Question 1

What type of disease is multiple sclerosis? Surgical sieve style

Answer 1

Demyelinating disease affecting the brain and spinal cord

Question 2

Overview of pathophysiology of multiple sclerosis

Answer 2

T cells attack myelin
B cells make antibodies to myelin
Then macrophages eat the oligodendrocytes

Question 3

Risk factors for multiple sclerosis

gene, sex, age range

Answer 3

HLA-DR2
Female sex
20-40 years old

Question 4

Types of multiple sclerosis (progression patterns)

Answer 4

- relapsing-remitting (80%)
50% within 10 years develop
- secondary progressive
- primary progressive (10-15%)
(progressing-relapsing)

Question 5

multiple sclerosis - diagnostic features

Answer 5

symptoms spread in time and space
MRI showing white matter plaques
CSF antibodies

Question 6

multiple sclerosis symptoms - charcots neurological triad

Answer 6

SIN
Slurred, scanning speech
Intention tremor
Nystagmus

Question 7

multiple sclerosis symptoms- visual ones

Answer 7

loss of vision (unilateral)
dark point on vision
blurring
optic neuritis (acute, painful loss of vision in one eye)

Question 8

optic neuritis is the presenting complaint of multiple sclerosis in 20% - what is it?

Answer 8

inflammation of optic nerve
acute, painful loss of vision in one eye over hours/a few days
colour vision impairment
perceived light flashes (photopsia)

Decreased pupillary light reaction in the affected eye
Relative afferent pupillary defect (RAPD) (swinging light test - bad eye contricts less)

Uhthoff’s phenomenon - worse when hot (bath)

methylprednisolone or leave to get better

Question 9

multiple sclerosis symptoms- eye movement ones

Answer 9

double vision

horizontal jerking nystagmus

Question 10

multiple sclerosis symptoms- psychiatric

Answer 10

poor concentration

depression anxiety

Question 11

multiple sclerosis symptoms- motor

Answer 11

muscle weakness, spasm, tremor, ataxia

Question 12

multiple sclerosis symptoms- sensory

Answer 12

numbness
pins and needles
paraesthesia (tingle, burn, itch)

Lhermittes sign - electric shock down back - spreads to limbs - when bending forward

Question 13

multiple sclerosis symptoms- bowels and urinary

Answer 13

incontinence etc

Question 14

treatment of multiple sclerosis

Answer 14

corticosteroids
cyclophosphamide
IV IgG

plasmapheresis

recombinant B-interferon