Multiple Sclerosis Flashcards
Do younger or older people normally get MS?
Younger
Is the presentation of MS consistent or variable?
Variable
What is MS a disease of?
The central nervous system, causing demyelination and inflammation which leads to focal disturbance of function
What is the prevalence of MS?
190/100,000 in Scotland
What does MS stand for?
Multiple sclerosis
When is the most common age of onset for MS?
About late 20s/30
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What is the initial presentation of MS?
Relapse (demyelination and inflammation)
Gradual onset over days
Stabilises days to week
Gradual resolution
Partial or complete recovery
What is seen during a relapse phase of MS?
Optic neuritis
Sensory symptoms
Limb weakness
Brainstem problems (cranial nerve involvement, pons-internuclear ophthalmoplegia, diplopia, vertigo/ataxia, upper motor neurons signs)
Spinal cord problems (bilateral motor and sensory symptoms, bladder involvement)
Myelitis
What is optic neuritis?
Subacute visual loss
What are clinical signs of optic neuritis?
Pain on moving eye
Colour vision disturbed
Initial swelling optic disc
Optic atrophy seen later
Relative afferent pupillary defect
What is pons-internuclear ophthalmoplegia?
Disorder of horizontal occular movement due to a lesion on the brainstem
What is diplopia?
Double vision
What is myelitis?
Inflammation of the spinal cord
Can be partial or transverse (complete)
What are the 2 different kinds of myelitis?
Partial or transverse (complete)
What is the clinical presentation of myelitis?
Weakness/upper motor neuron changes below level of demyelination
Bladder and bowel involvement
What is responsible for demyelination in MS?
Autoimmune process
Activated T cells cross blood brain barrier causing demyelination
What can demyelination in MS be seen by?
Lesions or plaques on MRI scan
What is the process of demyelination in MS?
1) Acute inflammation of myelin sheath
2) Loss of function
3) Repair
4) Recovery of function
5) Post inflammatory gliosis
6) May have funcitonal defect
What is gliosis?
Non-specific change of glial cells in response to damage to CNS
Usually hypertrophy (growth) or proliferation (increase in numbers) of glial cells
What are the different disease courses of MS?
Clinical isolated syndrome
Relapsing-remitting MS
Primary progressive MS
Secondary progressive MS
What is clinical isolated syndrome MS?
Refers to first episode of neurologic symptoms that last at least 24 hours
Sometimes no further episodes
What are further relapses of MS usually due to?
Underlying infection (25-30%)