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
What brainstem presentatoins are found in MS?
Diplopia, vertigo, dysarthria and pyramidal signs
26
What are common symptoms of MS?
Visual changes sNESORY SYMTPOMS clUMSY HAND OR LIMB aspASTICITY
27
How is MS diagnosed?
2 or more attacks affects 2 or more parts of the CNS
28
What is the preferred imaging for MS
MRI of the brain and cord
29
Whatis the advantage of MRI in MS
High sensitivity
30
How do lesions appear on MRI?
Oval, 2cm and perpendicular to the venricles
31
What lesions can be confused with MS lesions?
Small ischaemic lesions
32
why is cord MRI highly specific?
Unlikely to get ischaemic lesions here
33
What will CSF examination show and what is its utility?
Oligoclonal IgG bands in 90% of cases | But low specificity
34
What conditions can blood tests exclude?
Sarcoidosis, SLE, HIV
35
What is the significance of clinically isolated syndrome
Is the first episode of neurological symptoms suggesting neuroinflamaitno. But cannot make diagnosis
36
What is the likelihood of developing MS if have a MRI detected CIS?
85%
37
how are acute relapses managed?
Methylprednisolone
38
In what condition(s) are disease modifying drugs useful?
Remitting-relapsing MS
39
How can spasticity be managed?
Self; stretching, splinting Relaxants: baclofen, Intrathecal baclofen pump Injection: Botulinum toxin A
40
What is the prognosis of MS
Unpredictable, high MS lesion lad, high relapse rate and male gender are poor prognostic indicators