Multiple Sclerosis Flashcards
What is MS?
Where does it effect?
What 2 processes?
Acquired, chronic, immune-mediated inflammatory condition of the CNS
Brain, brainstem & spinal cord
Demyelination & gliosis
What is the mean age of onset?
What gender?
30 years
Female
What is the most common pattern of MS?
Relapsing-remitting (85%)
Describe RRMS
Relapses followed by remission and periods of stability
Symptoms may completely resolve in these times, but after several relapses there may be only partial recovery
What is Secondary progressive MS? (SPMS)
RRMS pattern at first, then the disease gradually worsens (with or without continued relapses)
After 6 years, what percentage of RRMS becomes SPMS?
About 25%
What is primary progressive MS? (PPMS)
Steady progression and worsening from onset
What is a relapse?
Onset of new symptoms/ worsening of current symptoms, lasting >24 hours
ABSENCE OF FEVER, INFECTION ETC
Give 4 risk factors for MS
FH
EBV
Smoking
Low vitamin D
What are the 4 most common presentations?
Optic neuritis
Transverse myelitis
Cerebellar
Brainstem syndromes
How does optic neuritis present?
Total unilateral visual loss over a few days
Pain behind the eye & on movement
What may be signs of optic neuritis on examination?
Reduced acuity
Scotoma
Reduced colour vision
RAPD
What is transverse myelitis?
Focal inflammation within the spinal cord
How does transverse myelitis present?
think sensory and motor
Sensory: paraesthesia
Motor: weakness below the level, ‘tight band sensation’
May be urinary symptoms
What are some cerebellar-related symptoms?
Ataxia, vertigo, clumsiness
What tests would you do in suspected cerebellar problems?
Finger-to-nose
Heal-to-toe walk
How may brainstem syndromes present?
Ataxia
Eye movement abnormalities (diplopia, nystagmus)
Speech problems
What is the MacDonald Criteria?
Method of diagnosing MS
E.g. >2 relapses/ initial episode where diagnosis not clear, may be said to have a CIS (clinically isolated syndrome), most will progress to MS
How are relapses managed?
Steroids (methylprednisolone)
How else can symptoms be managed?
Physiotherapy
Cognitive rehabilitation
