Multiple Sclerosis

Question 1

Where are white matter lesions seen in MS?

Answer 1

In the CNS

Question 2

What are some presenting features of MS?

Answer 2

Multiple lesions in space and time

Optic neuritis
Weakness
Sensory abnormalities
Paresthesia
Dizziness and vertigo
Diplopia and lesions of eye movement 
Internuclear ophthalmoplegia 
Fatigue
Bladder and bowel dysfunction
Depression and cognitive impairment

Question 3

Describe what is seen in internuclear ophthalmoplegia?

Answer 3

If patient asked to look to the left-
The abducted left eye will show nystagmus
The right eye fails to adduct fully

Due to a lesion in the Medial Longitudinal Fasciculus on the left side. Opposite is seen if it is on the right. It is indicative of MS.

Question 4

What is seen in relapsing remitting MS?

Answer 4

Relapsing remitting (Most common)- Episodes of relapse and remission but gradual loss of function after each episode

Question 5

What is the most common type of MS course?

Answer 5

Relapsing remitting

Question 6

What happens in relapsing remitting MS with secondary progression?

Answer 6

Usually begins as relapsing remitting and then a progressive course develops

Question 7

What is seen in primary progressive MS?

Answer 7

Gradual development of neurological deficits from the onset without any relapses

Question 8

What investigations might be done to diagnose MS?

Answer 8

MRI- Looking for white matter lesions
CSF Analysis- Looking for oligoclonal bands
Visual evoked potentials- measures speed of transmission which is reduced with white matter lesions- not widely used.

Question 9

Where are white matter lesions commonly seen?

Answer 9

Periventricular
Corpus callosum
Brainstem
Cerebellum

Question 10

What tests might be requested to investigate for MS?

Answer 10

Brain MRI
Lumbar puncture looking for oligoclonal bands
Visual evoked potentials

Question 11

What type of hypersensitivity is MS?

Answer 11

Type IV

Question 12

What might be used in the treatment of an acute episode or relapse MS?

Answer 12

Steroids- Methylprednisolone (More potent than prednisolone)

Question 13

Which gender is MS more common in?

Answer 13

Female gender- Like all autoimmune diseases

Question 14

What is Uhthoff’s phenomenon?

Answer 14

Seen in MS

Worsening of vision with increases in body temperature

Question 15

What is Lhermitte’s syndrome?

Answer 15

Flexion of the next causes electric shock like sensations

Question 16

Does MS cause UMN or LMN signs?

Answer 16

MS is a disease that affects the CNS and so it causes UMN signs:

Hyperreflexia
Hypertonia
Weakness- This is spastic weakness

Question 17

What disease modifying drugs may be used in MS?

Answer 17

Beta interferon has been shown to reduce relapse rate

Question 18

What is the criteria for beta interferons?

Answer 18

Patient with relapsing remitting course
Aged 18 or older
Can walk for at least 100m
2 or more relapses in past year

Question 19

How might fatigue be treated in MS?

Answer 19

Rule out other causes e.g. TFTs, Depression, Anaemia
Amantadine

Also mindfulness and CBT

Question 20

What might be used to treat spasticity in MS?

Answer 20

Baclofen
Dantrolene
Tizanidine
Physiotherapy

Question 21

What might be used to treat bladder dysfunction in MS?

Answer 21

Oxybutynin

Question 22

What is seen in acute disseminated encephalomyelitis?

Answer 22

Usually presents with encephalopathy (seizures, meningism) and features of myelitis, cerebral or cerebellar involvement
Half of patients report a preceding infectious illness

MRI shows white matter lesions and LP shows oligoclonal bands

Management: IV Methylprednisolone, IVIg