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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Where in the NS does MS affect?

A

CNS

White matter tracts

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2
Q

What is the pathology associated with MS?

A

Demyelination of nerve axons due to autoimmune process causing inflammation of myelin sheath

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3
Q

What scan allows the visualisation of plaques of demyelination?

A

MRI

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4
Q

What is seen on MRI with axonal loss?

A

Black holes

Cerebral atrophy

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5
Q

What is the aetiology of MS?

A 
Complex genetic inheritance
Associated with other autoimmune conditions 
F>M
Commoner in temperate climates 
VitD
EBV virus
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6
Q

What is the typical age of onset?

A

20-30s

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7
Q

How will MS usually present?

A

With a relapse = “Attack of demyelination”

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8
Q

What symptoms are observed in relapse of MS?

A

Optic neuritis
Sensory symptoms
Limb weakness
Brainstem diplopia, vertigo, ataxia

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9
Q

What is SYMPTOMS are observed with optic neuritis?

A

Subacute visual loss in one eye
Pain on eye movement
Loss of visual acuity
Swelling of optic disc

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10
Q

What are the differentials for optic neuritis?

A

Vit B12 deficiency
Wegeners granulomatosis
Local compression
Infection

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11
Q

If the cerebellum is involved in relapse, what likely symptoms will be observed?

A

Ataxia
Vertigo
Nystagmus

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12
Q

When can myelitis occur in MS?

A

Demyelination of the spinal cord

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13
Q

What symptoms will be observed with myelitis?

A 
Sensory level (hyperasthesia)
Wekness/ upper neuron changes below level 
Bladder & bowel problems
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14
Q

What are differentials for myelitis?

A

Tumour
Stroke
Infection

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15
Q

What is clinically isolated syndrome?

A

No further episodes after initial relapse

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16
Q

What is required for MS diagnosis?

A

Episodes of demyelination separated in space & time

17
Q

What symptoms may be observed in relapses of MS?

A 
Sensory loss
Optic nerve symptoms 
Limb weakness
Diplopia 
Vertigo 
Ataxia 
Sphincter disturbance
18
Q

What signs may be observed on examination?

A 
Hyperreflexia
Extensor plantars
Spasticity 
Weakness
Sensory loss
Abnormal eye movements 
Afferent pupillary defect
19
Q

How many areas of demyelination equate to 1 relapse?

A

10 Areas

20
Q

What other investigations may be done in addition to MRI?

A

Lumbar puncture - asses for oligoclonal bands in CSF

Bloods - look for inflammatory markers

21
Q

What are some of the differentials for MS?

A

Sarcoidosis
Vascultitis
Infection (Lyme Disease)

22
Q

What are the different types of MS?

A 
Relapsing - remitting (RRMS) -85%
Primary progressive (PPMS)
Secondary progressive (SPMS)
23
Q

What are some good prognostic indicators for MS?

A

Female
Presenting with optic neuritis
Long interval btw 1st & 2nd episodes
Few relapse in first 5 yrs

24
Q

What are some bad prognostic indicators for MS?

A

Male
Presenting in older age
Multifocal S & Ss
Motor symptoms

25
Q

What are the characteristics of PPMS?

A 
Presents in 50s/60s
No relapses 
Spinal symptoms 
Bladder symptoms 
Prognosis poor 
M:F
26
Q

What diseases are associated with neuromyelitis optic spectrum disorders?

A

Devics Disease =
Optic neuritis
Myelitis
Aquaporin-4 antibodies

27
Q

How can you treat acute relapse?

A

Look for underlying infection

Oral or IV prednisolone

28
Q

How do you treat further relapses?

A

Look for underlying viral infection

Vaccine is advised

29
Q

What is the 1st line therapies for disease modifying meds?

A

Beta-interferons
Glatiramer - these are all injectable

Teriflunomide
Dimethyl fumarate

30
Q

What do 1st line therapies prevent?

A

Reduce relapses by 1/3

No effect on disease progression

31
Q

What is a 2nd line disease modifying treatment?

A

Natalizumab

Fingolimod

32
Q

What are some of the risk factors associated with immunosuppression in MS?

A

Progressive Multifocal Leukencephalopathy (PML)

Activation of JC virus

33
Q

What other symptomatic meds bay be given?

A 
Antispasmodics (spasticity)
Anticholinergics (urinary)
Laxative (constipation)
Gabapentin (dysaesthesia)
Depression - CBT
Cognition - memory aid
Speech & swallowing - SALT

Neurology (16 decks)

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