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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

An idiopathic demyelinating disease of the CNS

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2
Q

What symptoms can occur as a result of demyelination in MS?

A

Loss of neurological function: weak legs, visual loss, urinary incontinence

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3
Q

What is the onset of MS?

A

Deficits develop gradually, last fro more than 24 hours and may gradually improve over days to weeks

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4
Q

What are the subtypes of MS?

A

Relapsing remitting
Primary progressive
Secondary progressive

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5
Q

Give examples of syndromes which may develop into MS?

A

Optic neuritis
Clinically isolated syndromes
Transverse myelitis
Radiological isolated syndromes

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6
Q

Describe the onset of optic neuritis?

A

Painful visual loss comes on over a few days. May resolve after a few weeks

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7
Q

What are the symptoms of transverse myelitis?

A

Weakness
Sensory loss
Incontinence

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8
Q

What is transverse myelitis?

A

Inflammation of the spinal cord

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9
Q

When can MS be definitively diagnosed?

A

Evidence of 2 or more episodes of demyelination which are disseminated in space and time

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10
Q

What are the possible causative factors of MS?

A

Genetic factors
Sunlight / vitamin D exposure
Viral trigger (possibly EBV)
Smoking

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11
Q

When should MS be suspected?

A

Neurological symptoms which develop over a few days
History of transient neurological symptoms that have lasted more than 24 hours and spontaneously resolved
‘hidden relapses such as optic neuritis, false diagnosis of Bell’s palsy or labrynthitis, sensory symptoms and bladder symptoms

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12
Q

What are the possible visual symptoms of MS?

A

Nystagmus
Optic neuritis
Diplopia

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13
Q

What are the possible central symptoms of MS?

A

Fatigue
Cognitive impairment
Depression
Unstable mood

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14
Q

What are the possible sensation symptoms of MS?

A

Pain
Hypoesthesias
Paraesthesias

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15
Q

What are the possible muscoloskeletal symptoms of MS?

A

weakness
spasms
ataxia

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16
Q

What are the possible throat/speech symptoms of MS?

A

Dysarthria

Dysphagia

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17
Q

What are the possible bowel symptoms of MS?

A

Incontinence

Diarrhoea or constipation

18
Q

What are the possible urinary symptoms of MS?

A

Incontinence

Frequency or retention

19
Q

When should conditions other than MS be expected?

A 
Sudden onset
Peripheral signs
Major cognitive involvement
reduced level of consciousness
Prominent seizures
Pyrexia/evidence of infection
Normal MRI scan
20
Q

What tests should be conducted to help with the diagnosis of MS?

A 
MRI
Lumbar puncture
Bloods
Visual evoked potentials
CXR
21
Q

What evidence should be seen on MRI to confirm a MS diagnosis?

A

Demyelination in 2 regions to indicate dissemination in space
If enhancing and non-enhancing areas of demyelination are seen this can indicate dissemination in time

22
Q

Oligoclonal bands are seen in MS. What are oligoclonal bands?

A

Immunoglobulin bands seen in blood and spinal fluid after protein electrophoresis. Presence of these bands in CSF but not in blood suggests that there is immunoglobulin production in the CNS.

23
Q

Other blood tests are used to exclude other causes of the presentation in possible MS. What blood tests are used?

A 
B12/folate
Serum ACE
Lyme serology
ESR/CRP
ANA/ANCA/Rheumatoid factor
Aquaporin 4 antibodies
24
Q

How is a relapse in MS defined?

A

Involves a new neurological deficit that lasts for more than 24 hours in the absence of pyrexia or infection

25
Q

What is a pseudo-relapse in MS?

A

Re-emergence of previous neurological symptoms or signs related to an old area of demyelination in the context of heat or infection

26
Q

All MS reloaded require treatment. T/F?

A

True

27
Q

What steroid regimen can be given to treat a relapse of MS?

A

1g of methylprednisolone for 3 days or 500mg of oral methylprednisolone for 5 days

28
Q

What should be given alongside steroids to treat an MS relapse?

A

A PPI for gastroprotection

29
Q

What risks are associated with alemtuzumab, used to treat MS?

A

Secondary autoimmune problems

30
Q

What risks are associated with natalizumab, used to treat MS?

A

Fatal PML if the patient is infected with the JC virus.

31
Q

How is natalizumab administered in MS?

A

Monthly infusions

32
Q

How is fingolimod administered in MS?

A

Daily tablet

33
Q

What risks are associated with the use of fingolimod in MS?

A

Risk of infections

Slow heart rate

34
Q

What risks are associated with the use of dimethyl fumarate in MS?

A

Low white cell counts

Risk of infection

35
Q

How is dimethyl fumarate administered in MS?

A

Twice daily tablet

36
Q

What is the action of cladribine in MS?

A

Targets B cells

37
Q

What type of MS can autologous haemopoetic stem cell transplant be used for?

A

Aggressive relapsing remitting MS

38
Q

What older treatments can be used in MS?

A

Beta interferon and Copaxone

39
Q

How are beta interferon and Copaxone administered in the treatment of MS?

A

Injections daily

40
Q

What is the potential treatment for primary progressive MS?

A

Ocrelizumab

41
Q

What is the potential treatment for secondary progressive MS?

A

Siponimod

42
Q

What is the advanatage to giving biotin in MS?

A

Some symptom relief, mild improvement in power, gives energy to damaged nerve cells

Neurology (10 decks)

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