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Neurology Clinical > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the main pathological process which causes multiple sclerosis?

A

Demyelination and inflammation of the neurones within the CNS
Disease of white matter in the CNS

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2
Q

What are the risk factors associated with MS?

A 
Genetic inheritance 
Female sex
Temperate climates 
Vitamin D
EBV
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3
Q

Describe what the age of exposure of risk refers to in someone’s risk of getting MS?

A

For example;
If someone was brought up in a a temperate climate i.e. scotland but moved to a more tropical / less temperate climate when they were >10 yrs old then they would still carry the risk for MS
However if they were born in scotland but moved to a more temperate climate before the age of 10 then they wouldn’t carry the risk that is associated with somewhere like scotland that has a temperate climate

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4
Q

What is the distrubution/prevalance of MS in females compare to males?

A

Females:male 2-3:1

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5
Q

Describe the pathophysiology of the demyelination in MS.

A

Autoimmune process
Activated T cells cross the BBB causing demyelination resulting in acute inflammation of the myelin sheath
Results in loss of function
Repair/recovery of function
Post inflammatory neurones may have deficits

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6
Q

What is the initial presentation of MS ?

A

In majority of cases, patients first present with a relapse - ‘attack of demyelination’ ;

  • gradual onset over days
  • stabilises within days/weeks
  • gradual resolution to complete or partial recovery
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7
Q

What symptoms do patients with MS experience with a relapse?

A

Optic neuritis
Sensory symptoms
Limb weakness
Brainstem i.e. diplopia, vertigo and/or axtaxia
Spinal cord i.e. Myelitis , dens/weakness, bilateral signs & symptoms and/or bladder & bowel symptoms

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8
Q

Is someone has presents with 1 relapse and recovers from this and doesn’t have another relapse, what is this termed as?

A

Clinically isolated syndrome (CIS)
They will not be diagnosed with MS because MS is characterised by having acute remitting relapses which show new areas of demyelination

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9
Q

Describe the presentation/symptoms of optic neuritis.

A 
Subacute visual loss 
Pain on moving the eye
Colour vision disturbed 
Initial swelling of optic disc in one eye
Relative afferent pupillary defect

Usually resolves over weeks
Optic atrophy seen later

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10
Q

Describe the presentation of someone with a brainstem relapse of MS.

A

Cranial nerve involvement
Involves the pons = internuclear ophalmoplegia
Involves the cerebellum = vertigo, nystagmus, ataxia

UMN signs
Sensory involvement

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11
Q

What is myelitis?

A

Inflammation / demyelination of the spinal cord

Commonly occurs as a relapse of MS

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12
Q

What si the presentation of myelitis?

A

Sensory loss often with band of hyperaesthesia
Weakness / UMN changes below level of demyelination
Bladder and bowel involvement i.e. incontinence
May be painful

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13
Q

As MS progresses, patients accumulate signs and symptoms which become debilitating even in between relapses.
What are some of these signs and symptoms?

A 
Fatigue 
Temperature sensitivity 
Sensory loss
Stiffness or spasms
Balance 
Slurred speech 
Swallowing problems 
Bladder & bowel symptoms i.e. incontinence 
Diplopia / oscillopsia / visual loss
Cognitive - dementia and emotional liability
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14
Q

What investigations can be carried out to diagnose and investigate MS?

A 
MRI
Lumbar puncture (oligoclonal bands)
Chest X ray
Bloods (detect any other inflammatory conditions present)
Visual / somatosensory evoked response
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15
Q

What is the name of the clinical and MRI criteria used to diagnose MS?

A 
MRI = Mac Donald criteria
Clinical = poser criteria
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16
Q

What is the correlation between the number of lesions found on patients MRI scan of demyelination and the amount of relapses they have?

A

For every approx 10 lesions a patient experiences 1 relapse

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17
Q

What do you have to be aware of when using an MRI scan to assess someone’s severity/diagnosis of MS?

A

Sometimes the the scan and a patients symptoms don’t correlate.
Someone could have many lesions on MRI but not experience as much / so severe symptoms as someone who has less lesions on a scan

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18
Q

Why are blood tests carried out when investigating someone with suspected MS?

A

To investigate if there is any other inflammatory process occurring

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19
Q

Why is a lumbar puncture carried out when investigating someone with suspected MS?

A

LP identifies if there are any oligoclonal bands in the CSF and compares them to see if there is present in the serum(blood)
Because only in MS are oligoclonal bands found in CSF but not blood

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20
Q

What are the differential diagnoses of MS?

A 
Acute disseminated encephalomyelitis (ADEM)
Other autoimmune conditions i.e. SLE
Sarcoidosis 
Vasculitis 
Infection i.e. Lyme disease, HTLV-1
Adrenoleucodystrophy
21
Q

What are the 3 types of MS?

A 
Relapsing remitting (RRMS)
Secondary progressive (SPMS)
Primary progressive (PPMS)
22
Q

What is the course of MS like in secondary progressive MS?

A

They first have a relapse, then completely heal back into remission.
They then experience another relapse but many years later.
After the 2nd relapse they don’t fully heal in remission and progressively get worse

23
Q

What is the course of MS like in primary progressive MS?

A

They first present with a relapse but don’t fully recover from it
From then on they continue to get worse and never recover

24
Q

What is permanent persistive disability over time due to?

A

Axonal loss (nerve cell loss)

25
Q

Which factors indicate a ‘good’ prognosis?

A

Female
Presents with optic neuritis
Long interval between 1st and 2nd relapse
Few relapses in 1st 5yrs

26
Q

What factors indicate a ‘bad’ prognosis?

A

Male
Older age
Multifactorial symptoms and signs
Motor symptoms and signs

27
Q

What type of MS often presents in the 5th / 6th decade?

A

Primary progressive (PPMS)

28
Q

What are the main symptoms in primary progressive MS?

A

Bladder / bowel symptoms

29
Q

What is the distribution between male and female regarding primary progressive?

A

Male female 1:1

30
Q

What is characteristic about the pathophysiology of neuromyelitis optic spectrum disorder?

A

Aquaporin-4-antibodies

31
Q

What are some of the disease modifying treatments for MS?

A

S/c or i/m injections:

  • beta interferon
  • glatiramer acetate

Oral treatments:

  • teriflunomide
  • dimethyl fumarate
32
Q

What are some of the side effects of the disease modifying treatments for MS?

A

Immunosuppression
Flu like symptoms
Injection site reaction
Abnormalities of blood count and liver function
Daily/weekly injection
Not a cute
No affect on progression of disease - only help by reducing no of relapses or speed of recovery from relapses

33
Q

What are the benefits of the disease modifying treatments for MS?

A

Reduce relapse rate by 1/3rd

34
Q

Immunosuppression is one of the main consequences of aggressive treatment of MS. What can this leave patients at risk of?

A

Progressive multifocal leukoencephalopathy (PML)

35
Q

What causes progressive multifocal leukoencephalopathy ?

A

JC virus

Can be contracted in MS patients who are immunosuppressed due to aggressive treatments

36
Q

What aggressive treatments for MS can cause patients to become immunosuppressed?

A

Natalizumab
Dimethyl fumarate
Fingolimod

37
Q

What are some of the treatment that are given for symptomatic treatment of spasticity in MS?

A

Anti spasmodic
Muscle relaxants
Physio therapy

38
Q

What are some of the treatment that are given for symptomatic treatment of dysaethesia in MS?

A

Amitriptyline

39
Q

What are some of the treatment that are given for symptomatic treatment of urinary complications/problems in MS?

A

Anticholinergic/bladder stimulator

Catheterisation

40
Q

What are some of the treatment that are given for symptomatic treatment of vision/ oscillopsia symptoms in MS?

A

Carbamazepine

41
Q

What are some of the treatment that are given for symptomatic treatment of difficulties in speech and swallowing in MS?

A

SALT

42
Q

If a patient with MS is on aggressive treatment, what are they at risk for and how do you test for this?

A

Progressive multifocal leukoencephalopathy (PML)

  • Annual MRI
  • JC antibody status
43
Q

What is the difference between neuromyelitis optics spectrum disorder and MS?

A

Neuromyelitis is an ‘attack’ of the optic nerve and the spinal cord and presents with optic neuritis and myelitis.
Whereas MS is an ‘attack’ on the whole of the CNS

44
Q

What is diagnostic of neuromyelitis optic spectrum disorder?

A

Aquaporin 4 antibodies

45
Q

How do you treat an acute relapse of optic neuromyelitis spectrum disorder?

A

Oral prednisolone

Symptomatic treatment

46
Q

What is internuclear ophthalmoloplegia?

A

CN III palsy in which the patients affected eye fails to adduct showing a contralateral gaze

47
Q

In a patient with MS, on MRI where is the most common site to find lesions?

A

periventricular area

near ventricles

48
Q

what does visual evoked potentials assess?

A

they look for evidence of previous demyelination of the optic nerve

49
Q

what is the medical term for muscle disease resulting in muscle weakness?

A

myopathy

Neurology Clinical (21 decks)

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