Multiple sclerosis Flashcards
what is multiple sclerosis?
inflammatory condition of the central nervous system
it is progressive demyelination of typical areas of ———— matter within the brain and spinal cord?
white
due to the limited capacity for re-myelination of axons this leads to defects in?
the rate and consistency of neuronal conduction
demyelination of white matter can occur
anywhere in the CNS
what is the most common phenotype of MS?
relapsing and remitting
what are plaques?
areas of demyelination
what is indicative of ongoing demyelination and inflammation?
active plaques
what is indicative or a burnt out active plaque?
inactive plaques
where are the common areas of demyelination? (4)
corpus callosum
optic nerve
periventricular white matter
cerebellar white matter
what are risk factors for developing MS? (5)
living in areas of higher latitude previous EBV infection 1st degree relative with MS Presence of HLA DRB1 common in young females
what is the presesntation of pyramidal dysfunction in mS?
features of upper motor neurone dysfunction
tonic spasms
what are examples of upper motor neurone dysfunction?
spasticity, weeakness, hyper-reflexia
where do upper motor neurone dysfunction tend to occur?
extensors of the upper limb and flexors of the lower limb
what type of tonic spasms are associated with MS?
frequent biref spasms of the lower limb
what is the preesentation of optic neuritis?
painful eye movements or visual loss
colour desaturation, loss of visual acuity
what is seeen in the swinging light test?
RAPD
what is seen on fundoscopy?
pale optic disc
what is a manifestation of brainstem demyelination affecting the medial longitudinal fasiculus on one or both sides?
internucleur ophtaahlmoplegia
what does INO cause?
horizontal diplopia
if you have a right INO
there is inability to adduct the right eye and a nystagmus of the left eye on attempted horizontal gaze to the left
what is pathognomonic of MS?
bilateral INO
there is a sensaation of ——– trickling down one’s skin
water
loss of sensation of DCLM tract manifested by?
clumsinesss due to loss of proprioception
in regards to trigeminal neuralgia what is important to pay attention to?
bilateral attacks, on both sides of the face
what is Lhermitte’s sign?
electric shock-like seensation down the upper limbs and trunk on neck flexion
what is Uhthoff’s phenomenon?
exacerbation of current symptoms in hor environments - i.e. after a hot shower
electric shock-like seensation down the upper limbs and trunk on neck flexion
Lhermitte’s sign
exacerbation of current symptoms in hor environments - i.e. after a hot shower
Uhthoff’s phenomenon
what are the symptoms of cerebellar dysfunction?
dysdiodochokinesia ataxia nystagmus intention tremor slurred speech hypotonia
what type of incontinence is associated with MS?
urge incontinence , retention
how do you diagnose MS?
evidence of two distinct neurological deficits occuring at different tyimes implicating lesions of white matter which are spatially and functionally distinct
what two tools can be used to confirm MS?
MRI imaging and CSF analysis
what is seen on MRI imaging of MS?
multiple white matter plaques
what is seen in CSF of MS?
presence of IgG Oligoclonal bands
how do you manage mild acute relapse?
symptomatic treatment
how do you manage moderate acute relapse?
oral prednisolone
relapse rates may ——— during pregnancy and may ————– 3–6 months after childbirth before returning to pre‑pregnancy rates
reduce
increase
there is a possible risk of ————- following flu vaccination if they relapse and remitting MS?
the possible risk of relapse after flu vaccination
encourage people with ms to?
exercise
what is the 1st line DMARD for relapsing-remitting disease? (3)
Tecfidera, Beta-interferon or Glatiramer Acetate
where 1st line therapy with DMARD has failed to control disease activity the following can be used? (3)
Tysabri (Natalizumab)
Fingolimod
what is natalizumab?
monoclonal antibody
what is the risk of tysabri?
risk of progressive multifocal leukoencephalopathy via JC infection
what type of DMARD is fingolimod?
sphingosine-1-phosphate inhibitor
when is Ocrelizumab used?
1st line in early primary progressive MS only
how do you manage spasticity?
physiotherapy and oral baclofen/gabapentin
how do you manage neuropathic pain?
gabapentin
how do you maanage fatigue?
amantadine +/- modafinil if excessive daytime sleepiness
how do you manage bladder dysfunction?
bladder physiotherapy, cathterisation in cases of retention and anticholinergic drugs (oxybutynin) in cases of urgee incontinence
what type of hypersensitivity reaction is MS?
type IV mediated or cell mediated hypersensitivity
what is charcot’s neurological triad?
Dysarthria
intention tremor
nystagmus
