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Neurology > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

what is multiple sclerosis?

A

inflammatory condition of the central nervous system

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2
Q

it is progressive demyelination of typical areas of ———— matter within the brain and spinal cord?

A

white

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3
Q

due to the limited capacity for re-myelination of axons this leads to defects in?

A

the rate and consistency of neuronal conduction

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4
Q

demyelination of white matter can occur

A

anywhere in the CNS

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5
Q

what is the most common phenotype of MS?

A

relapsing and remitting

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6
Q

what are plaques?

A

areas of demyelination

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7
Q

what is indicative of ongoing demyelination and inflammation?

A

active plaques

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8
Q

what is indicative or a burnt out active plaque?

A

inactive plaques

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9
Q

where are the common areas of demyelination? (4)

A

corpus callosum
optic nerve
periventricular white matter
cerebellar white matter

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10
Q

what are risk factors for developing MS? (5)

A 
living in areas of higher latitude 
previous EBV infection 
1st degree relative with MS 
Presence of HLA DRB1 
common in young females
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11
Q

what is the presesntation of pyramidal dysfunction in mS?

A

features of upper motor neurone dysfunction

tonic spasms

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12
Q

what are examples of upper motor neurone dysfunction?

A

spasticity, weeakness, hyper-reflexia

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13
Q

where do upper motor neurone dysfunction tend to occur?

A

extensors of the upper limb and flexors of the lower limb

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14
Q

what type of tonic spasms are associated with MS?

A

frequent biref spasms of the lower limb

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15
Q

what is the preesentation of optic neuritis?

A

painful eye movements or visual loss

colour desaturation, loss of visual acuity

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16
Q

what is seeen in the swinging light test?

A

RAPD

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17
Q

what is seen on fundoscopy?

A

pale optic disc

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18
Q

what is a manifestation of brainstem demyelination affecting the medial longitudinal fasiculus on one or both sides?

A

internucleur ophtaahlmoplegia

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19
Q

what does INO cause?

A

horizontal diplopia

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20
Q

if you have a right INO

A

there is inability to adduct the right eye and a nystagmus of the left eye on attempted horizontal gaze to the left

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21
Q

what is pathognomonic of MS?

A

bilateral INO

22
Q

there is a sensaation of ——– trickling down one’s skin

A

water

23
Q

loss of sensation of DCLM tract manifested by?

A

clumsinesss due to loss of proprioception

24
Q

in regards to trigeminal neuralgia what is important to pay attention to?

A

bilateral attacks, on both sides of the face

25
Q

what is Lhermitte’s sign?

A

electric shock-like seensation down the upper limbs and trunk on neck flexion

26
Q

what is Uhthoff’s phenomenon?

A

exacerbation of current symptoms in hor environments - i.e. after a hot shower

27
Q

electric shock-like seensation down the upper limbs and trunk on neck flexion

A

Lhermitte’s sign

28
Q

exacerbation of current symptoms in hor environments - i.e. after a hot shower

A

Uhthoff’s phenomenon

29
Q

what are the symptoms of cerebellar dysfunction?

A 
dysdiodochokinesia 
ataxia 
nystagmus 
intention tremor 
slurred speech 
hypotonia
30
Q

what type of incontinence is associated with MS?

A

urge incontinence , retention

31
Q

how do you diagnose MS?

A

evidence of two distinct neurological deficits occuring at different tyimes implicating lesions of white matter which are spatially and functionally distinct

32
Q

what two tools can be used to confirm MS?

A

MRI imaging and CSF analysis

33
Q

what is seen on MRI imaging of MS?

A

multiple white matter plaques

34
Q

what is seen in CSF of MS?

A

presence of IgG Oligoclonal bands

35
Q

how do you manage mild acute relapse?

A

symptomatic treatment

36
Q

how do you manage moderate acute relapse?

A

oral prednisolone

37
Q

relapse rates may ——— during pregnancy and may ————– 3–6 months after childbirth before returning to pre‑pregnancy rates

A

reduce

increase

38
Q

there is a possible risk of ————- following flu vaccination if they relapse and remitting MS?

A

the possible risk of relapse after flu vaccination

39
Q

encourage people with ms to?

A

exercise

40
Q

what is the 1st line DMARD for relapsing-remitting disease? (3)

A

Tecfidera, Beta-interferon or Glatiramer Acetate

41
Q

where 1st line therapy with DMARD has failed to control disease activity the following can be used? (3)

A

Tysabri (Natalizumab)

Fingolimod

42
Q

what is natalizumab?

A

monoclonal antibody

43
Q

what is the risk of tysabri?

A

risk of progressive multifocal leukoencephalopathy via JC infection

44
Q

what type of DMARD is fingolimod?

A

sphingosine-1-phosphate inhibitor

45
Q

when is Ocrelizumab used?

A

1st line in early primary progressive MS only

46
Q

how do you manage spasticity?

A

physiotherapy and oral baclofen/gabapentin

47
Q

how do you manage neuropathic pain?

A

gabapentin

48
Q

how do you maanage fatigue?

A

amantadine +/- modafinil if excessive daytime sleepiness

49
Q

how do you manage bladder dysfunction?

A

bladder physiotherapy, cathterisation in cases of retention and anticholinergic drugs (oxybutynin) in cases of urgee incontinence

50
Q

what type of hypersensitivity reaction is MS?

A

type IV mediated or cell mediated hypersensitivity

51
Q

what is charcot’s neurological triad?

A

Dysarthria
intention tremor
nystagmus

Neurology (10 decks)

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