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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What populations is MS most commonly diagnosed in?

A

Aged 20-40

Female:Male 3:1

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2
Q

What type of matter does MS affect?

A

White matter

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3
Q

How does demyelination occur in MS?

A

Auto immune process

Activated T cells cross blood brain barrier causing demyelination through acute inflammation of the myelin sheath

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4
Q

What may be present on an MRI scan in patients with MS?

A

Lesions/plaques indicating demyelination

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5
Q

How does MS progress pathologically?

A

Axonal loss key to progression of disease and development of persistent disability

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6
Q

How does axonal loss present on an MRI scan?

A

As black holes in the brain

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7
Q

What are the potential causes of MS?

A 
Complex genetic inheritance
Association with autoimmune disease
Female to male 3:1
Commoner in temperate climate
Age of exposure
Potential link to EBV and vitamin D exposure
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8
Q

How does MS initially present?

A

80% cases present with a relapse
This onsets gradually over days and stablisies within days to weeks, before gradually resolving to a full or partial recovery

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9
Q

What is the name of one episode of demyelination?

A

Clinically isolated syndrome

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10
Q

What are the symptoms of a relapse of MS?

A 
Optic neuritis
Sensory symptoms
Limb weakness
Brainstem diplopia/vertigo/ataxia
Spinal cord bilateral signs/symptoms with potential bladder problems
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11
Q

What are the signs and symptoms of optic or retobulbar neuritis?

A 
Subacute visual loss
Pain on moving eye
Relative afferent pupillary defect
Colour vision disturbed
Initial swelling of optic disc, with optic atrophy seen later
Usually resolves over weeks
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12
Q

What would be on a differential diagnosis for optic neuritis other than MS?

A 
Neuromyelitis optica
Sarcoidosis
Ischaemic optic neuropathy
Toxic/drugs/vitamin B12 deficiency
Wegeners granulomatosis
Local compression
Lebers hereditary optic neuropathy
Infection
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13
Q

What are the symptoms of a brainstem relapse?

A 
Cranial nerve involvement
Pons- internuclear opthalmoplegia
Cerebellum- vertigo, nystagmus, ataxia
UMN lesion signs in limbs
Sensory involvement
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14
Q

What are the symptoms of myelitis?

A

Hyperaesthesia
Weakness/UMN changes below level
Bladder and bowel involvement
May be painful

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15
Q

What would be on a differential diagnosis for myelitis other than MS?

A 
Inflammation due to sarcoidosis, neuromyelitis optica or SLE
Paraneoplastic process
Infection
Tumour
Stroke
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16
Q

When is a patient considered to be in the progressive phase of MS?

A

When they have multiple symptoms present at the same time

17
Q

What are the symptoms that can be associate with the progressive phase of MS?

A 
Fatigue
Temperature sensitivity
Sensory
Stiffness or spasms
Balance
Slurred speech
Swallowing difficulties
Bladder/bowel problems
Diplopia/visual loss
Cognitive dementia
18
Q

What signs may be present during examination of someone with progressive MS?

A 
Afferent pupillary defect
Nystagmus
Cerebellar signs
Sensory signs
Weakness
Spasticity
Hyperreflexia
Plantars extensor reflex
19
Q

How is MS diagnosed

A

Evidence of demyelination separated in time and space

Evidence can be clinical or MRI (Macdonald criteria)

20
Q

What other investigations may be useful in patients with MS other than an MRI?

A

Lumbar puncture (oliboclonal bands found in CSF but not serum is indicative of MS)
Bloods to exclude other inflammatory causes
Chest X-ray

21
Q

What is the difference between relapsing remitting, primary progressive and secondary progressive MS?

A

Relapsing remitting- episodic attacks of symptoms/demyelination that fade away with time
Primary progressive- symptoms gradually but consistently become worse over time
Secondary progressive-symptoms start as attacks but then become constant and worsen over time

22
Q

What are some indicators of a good prognosis of MS?

A

Female
Presents with optic neuritis
Long interval between first and second relapse
Few relapses in the first five years

23
Q

What are some indicators of a bad prognosis of MS?

A

Male
Older age
Multifocal symptoms/signs
Motor symptoms/signs

24
Q

What are the characteristics of primary progressive MS?

A 
Often presents in 5th and 6th decade
No relapses
Spinal symptoms
Bladder symptoms
M:F 1:1
25
Q

How is an acute relapse of MS managed?

A 
Look for an underlying infection
Exclude worsening of usual symptoms with intercurrent illness
Give oral or IV prednisolone
Rehabilitation
Symptomatic treatment
26
Q

What are the first line disease modifying treatments for MS?

A

Subcutaneous or intramuscular injections of beta-interferons and glatiramer acetate
Oral teriflunomide and dimethyl fumarate

27
Q

What are the side effects of the first line treatments of MS?

A

Injection site reaction
Flu-like symptoms
Abnormalities of blood count and liver function

28
Q

What are the second line disease modifying treatments for MS?

A

Natalizumab
Fingolimod
Alemtuzumub

29
Q

What are the symptomatic treatments for MS?

A

Spasticity- muscle relaxants, antispasmodics, physiotherapy
Dysaesthesia- amitriptyline, gabapentin
Urinary- anticholinergic Rx, bladder stimulation/catheterisation
Constipation- laxatives
Sexual dysfunction- sildenafil
SALT
Depression- CBT, medication

Neurology (29 decks)

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