Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Inflammatory condition of the nervous system causing demyelination of the nerves in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pattern of MS?

A

Focal disturbance of the the function of nerves occurs in episodes and follows a relapsing remitting occur.

Episode of demyelination —> malfunction —> remission (pattern and episodes are different for everyone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does demyelination occur?

A
  • Auto-immune process
  • Activated T cells cross blood brain barrier
  • Acute inflammation of myelin sheath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What occurs after the episode of demyelination?

A

Post-inflammatory gliosis -> functional deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is gliosis?

A

Reactive change (proliferation or hypertrophy) of glial cells in response to damage to the central nervous system (CNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does MS look like on an MRI scan?

A

Lesions and plaques (white blobs)

Axonal loss appears as black holes (in progressive disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is an MRI scan diagnostic of MS?

A

No, as blobs can present in old age - need to diagnose it clinically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does axonal loss lead to?

A

Disease progression and development of persistent disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the aetiology of MS?

A
  • Genetic inheritance
  • Association with autoimmune disease
  • Female

More prevalent the further away from the equator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what age does MS usually present?

A

20s and 30s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of relapse?

A
  • Optic neuritis
  • Sensory - i.e. numbness
  • Limb weakness
  • Brainstem diplopia/Vertigo/Ataxia-
  • Spinal cord - bilateral symptoms and signs +/- bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the symptoms of optic/retrobulbar neuritis?

A
  • Subacute visual loss
  • Pain on moving eye
  • Colour vision disturbed
  • Usually resolves over weeks
  • Initial swelling optic disc
  • Optic atrophy seen later
  • Relative afferent pupillary defect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is reflective afferent pupillary defect?

A

Demyelination in optic nerves, pupil doesn’t constrict as quickly as it should -> shown when shining light on eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are eight differential diagnosis’ of optic neuritis?

A
  • Neuromyelitis optica
  • Sarcoidosis
  • Ischaemic optic neuropathy
  • Toxic/ drugs/ B12 deficiency
  • Wegeners granulomatosis
  • Local compression
  • Lebers hereditary optic neuropathy
  • Infection-borrelia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the symptoms of brainstem relapse of MS?

A
  • Pons is susceptible to demyelination - internuclear ophthalmoplegia
  • Cerebellum - vertigo, nyastagmus, ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is myelitis?

A

Inflammation of myelin sheath
• Partial or transverse (complete)
• Hyperaesthesia (heightened sensitivity)

17
Q

What is the differential diagnosis of myelitis?

A 
• Inflammation due to:
- Neuromyelitis optica
- SLE
- sarcoidosis
• Infection or post infection
- (HIV, HTLV, HSV, TB, borrelia, mycoplasma etc)
• Tumour
• Paraneoplastic process
• Stroke
18
Q

What is Clinically Isolated Syndrome (CIS)?

A

One off episode of demyelination

For MS to be diagnosed there must be further episode -> second episode occurring in a different part of the CNS

19
Q

What is the clinical definition of MS?

A

Episodes of demyelination disseminated in space and time

20
Q

What are the symptoms of the progressive phase of MS?

A
  • Fatigue, temperature sensitivity
  • Sensory
  • Stiffness or spasms
  • Balance, slurred speech
  • Swallowing
  • Bladder + bowel
  • Diplopia/ oscillopsia/ visual loss
  • Cognitive-dementia/ emotional lability
21
Q

How is MS diagnosed?

A

Clinical or MRI based:
• Posers criteria (clinical)
• Macdonald criteria (MRI) - shows new areas of demyelination

22
Q

What are lesions or plaques on an MRI?

A

Areas of demyelination - can show more inflammation areas than episode patient experiencing (scan and patient symptoms don’t often correlate)

23
Q

How do MRI scans show new areas of demyelination?

A
  • Initial scan and then one 3 month later

* With and without use of gadolinium - new areas take gadolinium up

24
Q

What are other investigations used?

A
  • Lumbar puncture - presence of oligoclonal bands in CSF but not serum
  • Visual/somatosensory evoked
  • Bloods - exclude other inflammatory conditions
  • CXR (rule of sarcoidosis)
25
Q

What are differential diagnosis’ of MS?

A
  • Acute disseminated encephalopathy (ADEM)
  • Auto-immune conditions
  • Sarcoidosis
  • Vasculitis
  • Infection i.e. lyme disease
  • Adrenoleucodystrophy
26
Q

What are the three types of MS?

A
  1. Relapsing remitting (RRMS)
  2. Secondary progressive (SPMS)
  3. Primary progressive (PPMS)
27
Q

What are prognostic indicators in MS?

A 
Good for: 
• Female 
• Present with optic neuritis 
• Long interval between 1st and 2nd relapse 
• Few relapses in 1st 5yrs 
Bad for:
• Male 
• Older age 
• Multifocal symptoms and signs 
• Motor symptoms and signs
28
Q

What are the features of primary progressive MS (PPMS)?

A
  • Often presents in 5th and 6th decade
  • No relapses
  • Spinal symptoms - weakness in legs
  • Bladder symptoms
  • Prognosis poor
  • M = F
  • O bands in CSF
29
Q

What changes to MS during pregnancy?

A
  • Fewer relapses during pregnancy

* Increased risk in first 3 months post part

30
Q

What is the benefit of disease modifying treatment?

A

Reduce relapse rates

31
Q

Give examples of 1st line disease modifying treatments

A
  • Beta-interferons
  • Glatiramer acetate
  • Oral treatments
  • Teriflunomide
  • Dimethyl Fumarate
32
Q

What are the side effects of MS treatment?

A
  • Flu-like symptoms
  • Injection site reaction
  • Abnormalities of blood count and liver function
33
Q

Name three 2nd line disease modifying agents

A
  • Natalizumab
  • Fingolimod tablet
  • Alemtuzumub
34
Q

Name a life threatening side effect of MS treatment

A

Progressive Multifocal Leukencephalopathy (PML)

35
Q

What causes Progressive Multifocal Leukencephalopathy (PML)?

A 
• JC-virus
• Immunosuppression (AIDS)
- Natalizumab
- Dimethyl fumarate
- Fingolimod
36
Q

What is the symptomatic treatment of spasticity?

A

Muscle relaxants, antispasmodics and physio

37
Q

What is the symptomatic treatment of dysaesthesia?

A

Amitriptyline, gabapentin

Nervous System (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions