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*Nervous System - Pathology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

affects CNS; a white matter; demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged

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2
Q

Describe demyelination in MS

A

auto-immune process leading to loss of function; activated T cells cross the blood brain barrier causing demyelination; acute inflammation of myelin sheath

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3
Q

What would you expect to see on an MRI scan of someone with MS?

A

Lesions or plaques; black holes

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4
Q

What are ‘black holes’?

A

Area on an MRI where brain tissue has been lost as a result of inflammation in an MS plaque; later seen as cerebral atrophy

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5
Q

What is axonal loss important in?

A

Disease progression and development of persistent disability

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6
Q

Describe the pathogenesis of MS

A 
Complex genetic inheritance 
Association with autoimmune disease
Female:Male 2-3:1
Commoner in temperate climate 
Age of exposure - EB virus; vitamin D
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7
Q

Describe the typical presentation of a patient with MS

A

80% present with a relapse - ‘attack of demyelination’ or ‘inflammation’

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8
Q

Describe the onset of MS

A

Gradual onset over days which stabilises days to weeks (gradual resolution to complete or partial recovery)

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9
Q

What are the symptoms of a relapse?

A 
optic neuritis 
sensory symptoms
limb weakness
brainstem - diplopia/vertigo/ataxia
spinal cord - bilateral symptoms and signs +/- bladder
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10
Q

What are some features 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)
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11
Q

What is Clinically Isolated Syndrome?

A

First episode of neurological symptoms lasting at least 24 hrs - can be an indicator of what turns into MS; same symptoms as MS - treat with disease modifying drugs/investigate with MRI; sometimes no further episodes

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12
Q

When would further relapses occur?

A

May occur within months or years of first relapse; variable site and severity

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13
Q

Describe the progressive phase of MS

A

Accumulation of symptoms & signs:

  • Fatigue, temp sensitivity
  • Sensory symptoms
  • Stiffness/spasms
  • Balance/slurred speech
  • Swallowing difficulties
  • Bladder & bowel problems
  • Diplopia/oscillopsia/visual loss
  • Cognitive - dementia/emotional liability
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14
Q

What are the criteria used to diagnose MS?

A
  • Posers criteria = clinical
  • Macdonald criteria = MRI
    Scan and patient symptoms & signs often do not correlate - scan must be interpreted in context of clinical picture
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15
Q

Rule of thumb for number of lesions on MRI and relapses?

A

For approx every 10 lesions on MRI the patient experiences a relapse

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16
Q

What are the investigations for MS?

A
  • MRI
  • Lumbar puncture - oligoclonal bands present in CSF but not serum
  • Visual/somatosensory evoked response
  • Bloods - exclude other inflammatory conditions
  • CXR
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17
Q

What are some differential diagnoses of MS?

A 
ADEM
Other auto-immune disease e.g. SLE
Sarcoidosis
Vasculitis 
Infection e.g. Lyme disease, HTLV-1, borrelia
18
Q

What are the types of MS?

A
  • Relapsing remitting - 85% at outset (RRMS)
  • Primary progressive - 10-15% (PPMS)
  • Secondary progressive (SPMS)
19
Q

What are the good prognostic indicators for MS?

A

female
present with ON
long interval between 1st & 2nd relapse
few relapses in first 5 years

20
Q

What are the bad prognostic indicators for MS?

A

male
older age
multifocal symptoms & signs
motor symptoms & signs

21
Q

Describe primary progressive MS

A 
often presents in 5th/6th decade
no relapses
spinal symptoms
bladder symptoms
prognosis poor 
M:F 1:1
22
Q

Describe treatment of MS

A
  • general health & diet
  • treatment of relapse
  • symptomatic treatment
  • multi-disciplinary approach
  • disease modifying treatment
23
Q

What is the treatment for an acute relapse?

A 
LOOK FOR UNDERLYING INFECTION
Exclude worsening of usual symptoms with intercurrent illness
- oral prednisolone (IV)
- rehab
- symptomatic treatment
24
Q

Neuromyeltis Optica Spectrum Disorder is also known as Devic’s Disease, and is a differential diagnosis for MS, what are the symptoms?

A 
optic neuritis
myelitis
aquaporin-4 antibodies 
antibody negative in some cases
(treatment - immunosuppression)
25
Q

what are some 1st line MS treatments (daily-weekly s/c or i/m injections)?

A

beta-interferons
glatirmer acetate
(oral treatments; teriflunomide; dimethyl fumarate)

26
Q

what are side effects of 1st line MS treatments?

A

flu-like symptoms
injection site reaction
abnormalities of blood count and liver function

27
Q

what are some 2nd line MS treatments?

A

natalizumab (monthly infusion)
fingolimod (tablets)
alemtuzumub

28
Q

what is progressive mutlifocal leukencepalopathy (differential for MS) caused by?

A

JC-virus

immunosuppression (AIDS) from meds such as natalizumab, dimethyl fumarate or fingolimod

29
Q

how do we screen for PML?

A

MRI annual

JC antibody status

30
Q

symptomatic treatment for muscle spasticity in MS?

A

muscle relaxants
antispasmodics
physiotherapy

31
Q

symptomatic treatment for dyaesthesia in MS?

A

amitriptyline
gabapentin
etc

32
Q

symptomatic treatment for urinary problems in MS?

A

anticholinergic Rx
bladder stimulator
catheterisation

33
Q

symptomatic treatment for constipation in MS?

A

laxatives

34
Q

symptomatic treatment for sexual dysfunction in MS?

A

sildenafil

35
Q

symptomatic treatment for fatigue in MS?

A

graded exercise

medication

36
Q

symptomatic treatment for depression in MS?

A

CBT

medication

37
Q

symptomatic treatment for cognitive problems in MS?

A

memory aids etc

38
Q

symptomatic treatment for tremor in MS?

A

aids/pharmaceutical

39
Q

symptomatic treatment for vision problems/oscillopsia in MS?

A

carbamazepine

40
Q

symptomatic treatment for speech/swallowing problems in MS?

A

SALT (speech & language therapy)

41
Q

symptomatic treatment for motor/sensory impairment in MS?

A

multi-disciplinary team

42
Q

list the members of the MDT involved in MS?

A
  • MS nurse
  • physiotherapy
  • OT
  • SALT
  • Dietitian
  • Rehab specialists
  • Continence advisor
  • Psychology/psychiatry

*Nervous System - Pathology (13 decks)

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