Multiple sclerosis Flashcards
single episode of MS is called
clinically isolated syndrome of CNS demyelination
balance worse in the dark or when they are not looking at their feet
sensory ataxia
electric shock like sensation radiating down and up the spinal cord, provoked by flexion + extension of the neck, accompanied by paraesthesia in arms, legs, abdomen
L’Hermitte’s phenomenon
when to give MS disease modifying treatment
Patients experiencing 2 or more significant relapses over a 2 year period
what contrast material is injected prior to MRI brain to highlight areas of brain with active or recent inflammation
Gadolinium
management of secondary progressive MS
Betaferon: disease modifying drug
symptomatic treatment of Spasticity
Baclofen
symptomatic treatment of neuropathic pain
Gabapentin (anticonvulsant drug)
management of depressive symptoms in MS
sertraline
management of neuropathic bladder (urinary urgency + frequency)
Oxybutinin (anticholinergic drug)
how to assess amount of residual urine in bladder
ultrasound of bladder
MDT for MS
- physiotherapist
- occupational therapist
- language therapist
- neurorehabilitation consultant
- MS specialist nurse
what is MS
autoimmune disease that affects the CNS
women:men incidence
3:1
MS age affected
20-40 years old
relationship between equator and MS
the further away from the equator, lower the levels of Vit D and higher the incidence of MS
symptoms of optic neuritis
- blurred vision
- pain on eye movement
- colour desaturation
Uhthoff’s phenomenon is
visual fatigue as the nerve is not functioning as good as before due to excessive use of vision… may experience this with optic neuronitis
inflammation within cerebral hemispheres
fatigue, weakness, sensory disturbance
Cerebellar lesion
- slurred speech
- ataxia
- incoordination
spinal cord inflammation symptoms
- weakness
- sensory disturbance
- autonomic dysfunction
urinary features of spinal cord inflammation
incontinence, urgency, hesistency
pathophysiology of MS
demyelination along a nerve; the impulse is delayed and can also be blocked
4 types of MS
- relapsing-remitting
- secondary progressive
- primary progressive
- progressive-relapsing
what is secondary progressive MS?
after around 15 years of having relapsing-remitting MS, patients can have hardly any relapses and progressively worsen, with or without attacks
85-90% of MS is
relapsing-remitting MS
Investigations in MS
LP, MRI
how long do acute attacks last
varies,
1-2 months
LP findings in MS
- protein < 1 gram
- oligoclonal bands
4 MS mimics
- Anticardiolipin antibody syndrome
- Neuromyelitis optica/Devic’s syndrome
- Neurosarcoidosis
- Sjogren’s syndrome
what is Anticardiolipin antibody syndrome
inflammatory disease that can cause lesions in the CNS similar to MS
what is Neuromyelitis optica
inflammatory disorder of the CNS that causes longitudinally extensive transverse myelitis
transverse myelitis on MRI scan
inflammation spanning > 3 vertebral segments on MRI
Treatment of acute relapses
High dose steroids (oral/IV methylprednisolone)
for 5 days
