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MBBS III Sem II > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is Multiple Sclerosis

A

A chronic autoimmune T-cell inflammatory disorder of the CNS

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2
Q

What is the pathognomonic feature of MS?

A

Multiple plaques of demyelination throughout the brain, and spinal cord

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3
Q

What is the female:male ratio of MS

A

2:1

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4
Q

In what age group is MS most prevalent?

A

20-40 year olds

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5
Q

Where is MS most prevalent?

A

In Northern Countries

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6
Q

What cell type mediates MS?

A

T cells

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7
Q

What is the genetic predisposition to MS?

A

Polygenic inheritance pattern

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8
Q

Which genes are particularly important in MS?

A

HLA associated genes (HLA-DR15)

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9
Q

What viruses increase the risk of MS?

A

EBV and HHV-6

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10
Q

is the hygiene hypothesis relevant in MS?

A

Yes

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11
Q

what is the cardinal feature of MS

A

Plaques of demyelination, 2-10mm in size

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12
Q

Name 4 sites where MS plaques are most typically found?

A 
Optic Nerve
Periventricular regions
Corpus callosum
Brainstem
Spinal Cord
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13
Q

Are most inflammatory plaques symptomatic

A

No

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14
Q

Are peripheral nerves affected by MS?

A

No

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15
Q

What causes acute relapses of MS?

A

Focal inflammation causing myelin damage and conduction block

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16
Q

Why is there relapses of MS?

A

Reduced inflammation –> leads to remyelination

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17
Q

How come MS can become progressive?

A

Sever damage by focal inflammation destroys axons permanently

18
Q

Name the 4 types of MS progression

A

Relapsing-remitting MS
Secondary Progressive MS
Primary Progressive MS
Relapsing-progressive MS

19
Q

What is characteristic about RRMS?

A

Most common pattern, whereby attacks occur in relapses with complete recovery between symptomatic bouts

20
Q

what is characteristic about Secondary progressing MSS

A

Gradually worsening MS in a patient that was previously RRMS

21
Q

What happens in primary progressive MS

A

Gradually worsening disability without relapse or remission

22
Q

What is characterised hot relapsing-progressing MS?

A

It is primary progressive MS, that has occasional bouts

23
Q

What are the 3 characteristic presentations of MS

A

Optic neuritis
Brainstem demyelination
Spinal cord lesions

24
Q

What optic condition is pathognomonic of MS?

A

Bilateral internuclear ophthalmoplegia

25
Q

What brainstem presentatoins are found in MS?

A

Diplopia, vertigo, dysarthria and pyramidal signs

26
Q

What are common symptoms of MS?

A

Visual changes
sNESORY SYMTPOMS
clUMSY HAND OR LIMB
aspASTICITY

27
Q

How is MS diagnosed?

A

2 or more attacks affects 2 or more parts of the CNS

28
Q

What is the preferred imaging for MS

A

MRI of the brain and cord

29
Q

Whatis the advantage of MRI in MS

A

High sensitivity

30
Q

How do lesions appear on MRI?

A

Oval, 2cm and perpendicular to the venricles

31
Q

What lesions can be confused with MS lesions?

A

Small ischaemic lesions

32
Q

why is cord MRI highly specific?

A

Unlikely to get ischaemic lesions here

33
Q

What will CSF examination show and what is its utility?

A

Oligoclonal IgG bands in 90% of cases

But low specificity

34
Q

What conditions can blood tests exclude?

A

Sarcoidosis, SLE, HIV

35
Q

What is the significance of clinically isolated syndrome

A

Is the first episode of neurological symptoms suggesting neuroinflamaitno. But cannot make diagnosis

36
Q

What is the likelihood of developing MS if have a MRI detected CIS?

A

85%

37
Q

how are acute relapses managed?

A

Methylprednisolone

38
Q

In what condition(s) are disease modifying drugs useful?

A

Remitting-relapsing MS

39
Q

How can spasticity be managed?

A

Self; stretching, splinting
Relaxants: baclofen, Intrathecal baclofen pump
Injection: Botulinum toxin A

40
Q

What is the prognosis of MS

A

Unpredictable, high MS lesion lad, high relapse rate and male gender are poor prognostic indicators

MBBS III Sem II (16 decks)

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