multiple sclerosis Flashcards
what is multiple sclerosis?
white matter disease
Demyelination-”inflammation”
focal disturbance of function-relapse
relapsing remitting course
. An autoimmune attack occurs on the myelin sheath that surrounds nerve fibres and results in less efficient transmission of nerve impulses
what is the prevelance of MS
Prevalence ~190 per 100 000 in Scotland
what is the initial presentation of MS?
relapse
demyelination
“inflammation”
Gradual onset over days
Stabilises days to weeks
Gradual resolution
Partial or complete recovery
what occurs in relapse?
Optic neuritis Sensory symptoms Limb weakness Brainstem Diplopia Vertigo/Ataxia Spinal cord bilateral motor and sensory symptoms Bladder involvement
what happens in optic/retrobulbar neuritis?
Subacute visual loss
Pain on moving eye
Colour vision disturbed
Usually resolves over weeks
what are the symptoms of a brainstem relapse located at pons?
Pons- internuclear ophthalmoplegia
what are the symptoms of a brainstem relapse located at cerebellum?
vertigo, nystagmus, ataxia
what is Myelitis
inflammation of the spinal cord which can disrupt the normal responses from the brain to the rest of the body, and from the rest of the body to the brain. Inflammation in the spinal cord, can cause the myelin and axon to be damaged resulting in symptoms such as paralysis and sensory loss.
can myelitis be partial or transverse?
can be both
what else can myelitis lead to?
Sensory level often with band of hyperaesthesia
Weakness/ upper motor neurone changes below level of demyelination
how is demylination caused?
Activated T cells cross blood brain barrier causing demyelination
what does demyelination cause?
Acute inflammation of myelin sheath
Loss of function
Repair
Recovery of function
Post inflammatory gliosis
may have functional deficit
Lesions or plaques on MRI scan
whats the difference between MS and demyelination?
MS=episodes of demyelination disseminated in space and time
what would show progression of the disease on the MRI?
Black holes
what are the symptoms and signs of progression of the disease?
Fatigue, temperature sensitivity Sensory Stiffness or spasms Balance, slurred speech Bladder & bowel Diplopia/ oscillopsia/ visual loss
Swallowing
Cognitive-dementia/ emotional lability
on examinating a patient with progressing MS, what would you see?
Afferent pupillary defect Nystagmus or abnormal eye movements Cerebellar signs Sensory signs Weakness Spasticity Hyperreflexia Plantars extensor
when does primary progressive MS start?
5th and 6th decade
what kind of symptoms do you get with primary progressive MS?
Spinal symptoms
Bladder symptoms
what are differential diagnosis with MS?
Acute Disseminated Encephalomyelitis (ADEM) Other Auto-immune conditions eg SLE Sarcoidosis Vasculitis Infection eg Lyme disease, HTLV-1 Adrenoleucodystrophy etc etc
what are differential optic neuritis?
Neuromyelitis optica Sarcoidosis Ischaemic optic neuropathy Toxic/ drugs/ B12 deficiency Wegeners granulomatosis Local compression Lebers hereditary optic neuropathy Infection-TB, HIV
what are differential diagnosis myelitis?
Inflammation Neuromyelitis optica SLE sarcoidosis Infection...or post infection (HIV, HTLV, HSV, TB, borrelia, mycoplasma etc) Tumour Paraneoplastic process Stroke
what investigations would you do?
Lumbar puncture-oligoclonal bands present in CSF but not serum
Visual/ somatosensory evoked response
Bloods-exclude other inflammatory conditions
Chest X Ray
for disease modifying treatments what is 1st line treatments?
s/c or i/m injections
Beta-interferons
glatiramer acetate
Oral treatments
Teriflunomide
Dimethyl Fumarate
what are 2nd line agents?
Natalizumab
Fingolimod
Cladribine
Ocrelizumab (?PPMS)
Alemtuzumub
