Multiple Sclerosis Flashcards
Define MS [2]
Inflammatory Autoimmune [1] Demyelinating (white matter) disease of the CNS [1]
When does MS generally present? [2]
40-50 years, peak age of incidence Primary Progressive (PPMS) tends to show up later in life (50s/60s)
Describe the course of a typical MS relapse [2]
A few days gradual onset of symptoms [1] then it takes a few weeks to stabilize and they recover slowly in hospital. [1]
How could an MS attack present?
Describe 2 vague symptoms and 8 focal symptoms
Vague symptoms - Fatigue - Headache Focal symptoms - Sensory disturbance - Limb weakness - Visual symptoms - Myelitis - Vertigo - Ataxia - Sphincter disturbance - Mental changes
Explain why optic neuritis occurs and the symptoms [5]
Optic neuritis
- Unilateral decrease in visual acuity over hours or days
- Visual loss: central scotoma to complete visual loss
- Pain on moving the eye as this irritates dural membrane around eye
- Poor discrimination of colours, ‘red desaturation’
- Swelling and/or atrophy of the optic disc (papillitis)
- Relative afferent pupillary reflex
What is Uthoff’s phenomenon [1]
Symptoms returning transiently following hot bath or physical exercise ie rise in body temp
- What are the types of myelitis? [1]
2. What are the effects of myelitis? [3]
- Partial (one sided) or transverse (complete)
- Weakness & UMN syndrome below the level of the myelitis
- The affected level may have hyperaesthesia (physical hypersensitivity)
- Bladder & Bowel Symptoms
How would a brainstem relapse present? [4]
- Cranial Nerve Involvement
- Cerebellum (Vertigo, ataxia, nystagmus)
- Can affect the sensory fibres or UMNs
- Internuclear Opthalmoplegia
What is internuclear ophthalmoplegia? [3]
Due to a lesion in the medial longitudinal fasciculus, which connects the IIIrd, IVth and VIth cranial nuclei [1]
Impaired adduction of the eye on the same side as the lesion
Horizontal nystagmus of the abducting eye on the contralateral side
What does RAPD show in MS?
What kind of sensory symptoms can occur in an MS relapse? [4]
Impaired afferent conduction in CN II, lesion in the pupillary reflex pathway
Numbness, tingling, lack of sensation or pain are common, facial pain (trigeminal neuralgia)
What kind of motor symptoms come with an MS relapse? [2]
What signs of lesions affecting motor can we see? [4]
Monoparesis
Paraparesis
Signs
- Increased tone
- Hyperreflexia
- Extensor plantar responses
- Pyramidal weakens
How do we diagnose MS? [1]
Name 2 criteria
Remember MS is recurrent episodes of demyelination disseminated by time & space, just one episode isnt yet MS [1]
Either clinically using Poser’s Criteria
Or by MRI using Macdonald’s Criteria
How does MS appear on an MRI, explain how an early vs late plaque would look differently [2]
- Sites of recent inflammation show up as white lesions or plaques
- Axonal loss then appears as black holes and in severe cases as cerebral atrophy
If you are unsure its MS after an MRI, what other tests can be done? [3]
- Bloods looking for other inflammatory conditions
- CXR for inflammatory conditions like Sarcoidosis
- LP, oligoclonal bands in CSF but not in the blood indicates MS
What are the types of MS? [5]
- Relapsing Remitting (RRMS) 85% of cases at the outset
- Secondary Progressive (SPMS)
- Primary Progressive (PPMS)
- Sensory MS
- Malignant MS
Describe the pattern of Relapsing Remitting MS? [1]
Episodes of demyelination causing varying severity of symptoms with complete recovery [1] between relapses
(most eventually become SPMS)
Describe the pattern of Secondary Progressive MS?
A progressive neurological disability after an initial RRMS course.
Describe the pattern of Sensory MS? [1]
Minor episodes of sensory symptoms with good recovery
Describe the pattern of primary progressive MS? [1]
Progressively worsening disability right from the outset
What would indicate a worse prognosis for MS? [6]
- Male
- Older
- Multifocal Signs/Symptoms
- Motor Symptoms
- Close 1st & 2nd relapse
- Lots of relapses in the 1st 5 yrs
Whats different about Primary Progressive MS? [2]
Whats the prognosis?
It usually presents in the 50s or 60s rather than in youth
No gender predisposition
Poor Prognosis
Autoimmune inflammatory diseases
What is Devic’s Disease? [2]
Neuromyelitis Optic Spectrum Disorder
It used to be considered a varient of MS but is now considered its own clinical entity.
Its myelitis and optic neuritis [1] mediated by aquaporin-4 antibodies [1] and treated with immunosuppression
How do we treat an acute relapse of MS? [4]
- Look for an underlying infection
-1st line: oral methylprednisolone 0.5g daily for 5 days - Rehabilitation
- Symptom treatment
- If failed or not tolerated on severe relapse: admission for IV methylprednisolone
Also vaccinate against viral infections to reduce future relapses
What are disease modifying treatments? [2]
Treatments that reduce the relapse rate [1]
however they dont slow progression or reduce the severity of the disease [1]
