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Neurology - Year 2 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the initial presentation on MS?

A

Gradual onset over days
Stabilises days to weeks
Gradual resolution
Partial or complete recovery

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2
Q

What is the presentation of a relapse?

A 
Optic neuritis
Sensory symptoms
Limb weakness
Brainstem (diplopia, vertigo/ataxia)
Spinal cord (bilateral motor+sensory symptoms, bladder involvement)
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3
Q

What are the signs on optic neuritis?

A 
Subacute visual loss
Pain on moving eye
Colour vision disturbed
Usually resolves over weeks
Initial swelling optic disc
Optic atrophy seen later
Relative afferent pupillary defect
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4
Q

What happens in a brainstem relapse?

A 
CN involvement
Pons-internuclear opthamoplegia
Cerebellum - vertigo, nystagmus, ataxia
UMN signs
Sensory involvement
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5
Q

What is myelitis?

A

Can be partial or transverse
Sensory level often with band of hyperaesthesia
Weakness/UMN changes below level of demyelination
Bladder and bowel involvement

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6
Q

How does demyelination occur?

A

Autoimmune process
Activated T cells cross BBB causes demyelination
Acute inflammation of myelin sheath causes loss of function
Lesions or plaques on MRI scan

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7
Q

What can occur with further relapse?

A 
Optic nerve damage
Sensory
Limb weakness
Diplopia
Vertigo
Ataxia
Sphincter disturbance
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8
Q

What accumulation of symptoms and signs are common in progressive phase of MS?

A 
Fatigue, temperature sensitivity
Sensory
Stiffness/spasms
Balance, slurred speech
Bladder and bowel issues
Diplopia/oscillopsia/visual loss
Swallowing difficulties
Cognitive - dementia/emotional liability
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9
Q

What are common findings of examination in MS?

A 
Afferent pupillary defect
Nystagmus/abnormal eye movements
Cerebellar signs
Sensory signs
Weakness
Spasticity
Hyperreflexia
Plantars extensor
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10
Q

What are the different types of MS?

A 
Relapsing remitting (85%)
Secondary progressive 
Primary progressive (10-15%)
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11
Q

What are the common characteristics of primary progressive MS?

A 
Often in 5th and 6th decade
No relapses
Spinal symptoms
Bladder symptoms
Poor prognosis
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12
Q

How is MS diagnosed?

A 
Can be clinical or MRI based diagnosis
Posers criteria (clinical)
Macdonald criteria (MRI)
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13
Q

What is the differential diagnosis of MRI lesions and plaques?

A 
Acute disseminated encephalomyelitis (ADEM)
Other auto-immune conditions
Sarcoidosis
Vasculitis
Infection
Adrenoleucodystrophy
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14
Q

What is the differential for optic neuritis?

A 
Neuromyelitis optica
Sarcoidosis
Ischaemic optic neuropathy
Toxic/drugs/B12 deficiency
Wegeners granulomatosis
Local compression
Lebers hereditary optic neuropathy
Infection - TB, HIV
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15
Q

What is the differential diagnosis of myelitis?

A 
Inflammation
Infection
Tumour
Paraneoplastic process
Stroke
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16
Q

What other investigations are good for diagnosing MS?

A

Lumbar puncture
Visual/somatosensory evoked response
Bloods (inflammatory)
CXR

17
Q

How is MS treated?

A

General health and diet
Symptomatic treatment
Multi-disciplinary approach

18
Q

How is acute relapse treated?

A

Oral prednisolone (IV)
Rehabilitation
Symptomatic treatment

19
Q

What is the 1st line treatments for MS?

A

Injection: beta-interferons/glatiramer acetate
Oral: teriflunomide, dimethyl fumarate

20
Q

What are the 2nd line agents for MS?

A 
Natalizumab
Fingolimod
Cladribine
Ocrelizumab
Alemtuzumub
21
Q

What are the cons of disease modifying treatment?

A 
Not a cure
Reduce relapse rate
Do not slow progression
Side effects
Immunosuppression
22
Q

What are symptomatic treatment for spasticity?

A

Muscle relaxants
Antispasmodics
Physiotherapy

23
Q

What are symptomatic treatment for dysaesthesia?

A

Amitriptyline Rx
Bladder stimulator
Catherisation

24
Q

What are the symptomatic treatments for constipation?

A

Laxatives

25
Q

What are the symptomatic treatments for sexual dysfunction?

A

Sildenafil

26
Q

What are the symptomatic treatments for fatigue?

A

Graded exercise

Medication

27
Q

What are the symptomatic treatments for depression?

A

CBT

Medication

28
Q

What are the symptomatic treatments for cognitive symptoms?

A

Memory aids

29
Q

What are the symptomatic treatments for tremor?

A

Aids

Medication

30
Q

What are the symptomatic treatments for vision/oscillopsia?

A

Carbamazepine

31
Q

What are the symptomatic treatments for speech/swallowing issues?

A

SALT

32
Q

What are the symptomatic treatments for motor/sensory impairment?

A

Multi-disciplinary team

33
Q

What MDT staff are involved in MS care?

A 
MS nurse
Physiotherapy
Occupational therapy
Speech and language therapy
Dietician
Rehab specialists
Continence advisor
Psychology/psychiatry

Neurology - Year 2 (12 decks)

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