Multiple Sclerosis Flashcards
What is MS?
inflammatory demyelinating disease characterised by:
- presence of episodic neurological dysfunction
- in >2 areas of CNS (brain, spinal cord, and optic nerves)
- separated in time and space
What are the 4 subtypes of MS?
- Clinically isolated syndrome (CIS)
- Relapsing-remitting MS (RRMS)
- Primary progressive MS (PPMS)
- Secondary progressive MS (SPMS)
What are the risk factors for MS?
- female
- northern (white) race
weak:
- genetics
- smoking
- Vit D deficiency
- autoimmune disease
- EBV
Which patients does MS classicaly present in?
- white women
- aged between 20-40 years
- with temporary visual or sensory loss
Summarise the epidemiology of MS
- UK prevalence: 1/1000
- 2 x as common in FEMALES
- Age of presentation: 20-40 yrs
What are the presenting symptoms of MS?
Varies depending on the site of inflammation
Optic Neuritis (COMMONEST)
- Unilateral deterioration of visual acuity and colour perception Pain on eye movement
- Common first symptoms of multiple sclerosis
Sensory
- Parasthesia
- Numbness
- Burning
Motor
- Limb weakness
- Spasms
- Stiffness
- Heaviness
Autonomic
- Urinary urgency
- Hesitancy
- Incontinence
- Impotence
Psychological
- Depression
- Psychosis
Uhthoff’s Sign - worsening of neurological symptoms as the body gets overheated from hot weather, exercise, saunas, hot tubs etc.
Lhermitte’s Sign - an electrical sensation that runs down the back and into the limbswhen the neck is flexed
What are the signs of MS O/E?
Optic Neuritis
- Impaired visual acuity (MOST COMMON)
- Loss of coloured vision
Visual Field Testing
- Central scotoma (if optic nerve is affected)
- Scotoma = a blind spot in the normal visual field
- Field defects (if optic radiations are affected)
Relative Afferent Pupillary Defect (RAPD) - i.e. Marcus Gunn pupil
Internuclear Ophthalmoplegia
- Lateral horizontal gaze causes failure of adduction of the contralateral eye
- Indicates lesion of the contralateral medial longitudinal fasciculus
Sensory
- Paraesthesia
Motor
- UMN signs
Cerebellar
- Limb ataxia (intention tremor, past-pointing, dysmetria)
- Dysdiadochokinesia
- Ataxic wide-based gait
- Scanning speech
What are the primary investigations for ?MS ?
-
MRI brain
- high field (1.5 Tesla or above) magnet, with intravenous contrast.
-
MRI spinal cord
- cervical spinal cord lesions
- Bloods: FBC - to exclude other causes
- Bloods: comprehensive metabolic panel - to exclude other causes
- Bloods: TSH - to exclude other causes
- Bloods: Vit B12 - to exclude other causes
Which bloods tests are included in the comprehensive blood panel?
- Glucose
- Calcium
- Proteins: Albumin and total blood protein
- Electrolytes: Sodium, potassium, carbon dioxide, and chloride
- Kidney tests: BUN (blood urea nitrogen) and creatinine
- Liver tests: ALP (alkaline phosphatase), ALT (alanine aminotransferase), AST (aspartate aminotransferase), and bilirubin
Which blood tests are included in an FBC?
- Hb
- MCV
- Reticulocyte count
- Red cell count
- HCT/PCV
- MCH
- MCHC
- Red cell width (RCW)
