Multiple Sclerosis Flashcards
What is Multiple Sclerosis
A chronic autoimmune T-cell inflammatory disorder of the CNS
What is the pathognomonic feature of MS?
Multiple plaques of demyelination throughout the brain, and spinal cord
What is the female:male ratio of MS
2:1
In what age group is MS most prevalent?
20-40 year olds
Where is MS most prevalent?
In Northern Countries
What cell type mediates MS?
T cells
What is the genetic predisposition to MS?
Polygenic inheritance pattern
Which genes are particularly important in MS?
HLA associated genes (HLA-DR15)
What viruses increase the risk of MS?
EBV and HHV-6
is the hygiene hypothesis relevant in MS?
Yes
what is the cardinal feature of MS
Plaques of demyelination, 2-10mm in size
Name 4 sites where MS plaques are most typically found?
Optic Nerve Periventricular regions Corpus callosum Brainstem Spinal Cord
Are most inflammatory plaques symptomatic
No
Are peripheral nerves affected by MS?
No
What causes acute relapses of MS?
Focal inflammation causing myelin damage and conduction block
Why is there relapses of MS?
Reduced inflammation –> leads to remyelination
How come MS can become progressive?
Sever damage by focal inflammation destroys axons permanently
Name the 4 types of MS progression
Relapsing-remitting MS
Secondary Progressive MS
Primary Progressive MS
Relapsing-progressive MS
What is characteristic about RRMS?
Most common pattern, whereby attacks occur in relapses with complete recovery between symptomatic bouts
what is characteristic about Secondary progressing MSS
Gradually worsening MS in a patient that was previously RRMS
What happens in primary progressive MS
Gradually worsening disability without relapse or remission
What is characterised hot relapsing-progressing MS?
It is primary progressive MS, that has occasional bouts
What are the 3 characteristic presentations of MS
Optic neuritis
Brainstem demyelination
Spinal cord lesions
What optic condition is pathognomonic of MS?
Bilateral internuclear ophthalmoplegia
What brainstem presentatoins are found in MS?
Diplopia, vertigo, dysarthria and pyramidal signs
What are common symptoms of MS?
Visual changes
sNESORY SYMTPOMS
clUMSY HAND OR LIMB
aspASTICITY
How is MS diagnosed?
2 or more attacks affects 2 or more parts of the CNS
What is the preferred imaging for MS
MRI of the brain and cord
Whatis the advantage of MRI in MS
High sensitivity
How do lesions appear on MRI?
Oval, 2cm and perpendicular to the venricles
What lesions can be confused with MS lesions?
Small ischaemic lesions
why is cord MRI highly specific?
Unlikely to get ischaemic lesions here
What will CSF examination show and what is its utility?
Oligoclonal IgG bands in 90% of cases
But low specificity
What conditions can blood tests exclude?
Sarcoidosis, SLE, HIV
What is the significance of clinically isolated syndrome
Is the first episode of neurological symptoms suggesting neuroinflamaitno. But cannot make diagnosis
What is the likelihood of developing MS if have a MRI detected CIS?
85%
how are acute relapses managed?
Methylprednisolone
In what condition(s) are disease modifying drugs useful?
Remitting-relapsing MS
How can spasticity be managed?
Self; stretching, splinting
Relaxants: baclofen, Intrathecal baclofen pump
Injection: Botulinum toxin A
What is the prognosis of MS
Unpredictable, high MS lesion lad, high relapse rate and male gender are poor prognostic indicators
