Multiple Sclerosis Flashcards
Where are white matter lesions seen in MS?
In the CNS
What are some presenting features of MS?
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
Describe what is seen in internuclear ophthalmoplegia?
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.
What is seen in relapsing remitting MS?
Relapsing remitting (Most common)- Episodes of relapse and remission but gradual loss of function after each episode
What is the most common type of MS course?
Relapsing remitting
What happens in relapsing remitting MS with secondary progression?
Usually begins as relapsing remitting and then a progressive course develops
What is seen in primary progressive MS?
Gradual development of neurological deficits from the onset without any relapses
What investigations might be done to diagnose MS?
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.
Where are white matter lesions commonly seen?
Periventricular
Corpus callosum
Brainstem
Cerebellum
What tests might be requested to investigate for MS?
Brain MRI
Lumbar puncture looking for oligoclonal bands
Visual evoked potentials
What type of hypersensitivity is MS?
Type IV
What might be used in the treatment of an acute episode or relapse MS?
Steroids- Methylprednisolone (More potent than prednisolone)
Which gender is MS more common in?
Female gender- Like all autoimmune diseases
What is Uhthoff’s phenomenon?
Seen in MS
Worsening of vision with increases in body temperature
What is Lhermitte’s syndrome?
Flexion of the next causes electric shock like sensations
Does MS cause UMN or LMN signs?
MS is a disease that affects the CNS and so it causes UMN signs:
Hyperreflexia
Hypertonia
Weakness- This is spastic weakness
What disease modifying drugs may be used in MS?
Beta interferon has been shown to reduce relapse rate
What is the criteria for beta interferons?
Patient with relapsing remitting course
Aged 18 or older
Can walk for at least 100m
2 or more relapses in past year
How might fatigue be treated in MS?
Rule out other causes e.g. TFTs, Depression, Anaemia
Amantadine
Also mindfulness and CBT
What might be used to treat spasticity in MS?
Baclofen
Dantrolene
Tizanidine
Physiotherapy
What might be used to treat bladder dysfunction in MS?
Oxybutynin
What is seen in acute disseminated encephalomyelitis?
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
