Multiple Sclerosis Flashcards
what is MS
inflammatory demyelinating disorder of the CNS
what is meant by plauqes
areas of inflammation caused by T-cell mediated response
what are the 4 patterns of MS
Relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive
how does demyelination cause symptoms
acute relapses are caused by focal inflammatory demyelination – causes conduction block
severe damage causes permanent axonal destruction
how does MS normally present
monosymptomatic unilateral optic neuritis numbness/tingling in limbs leg weakness ataxia
what are signs of pyramidal dysfunction
increased tone
spasticity
weakness
affects extensors of upper limbs and flexors of lower limbs
what is Sx of optic neuritis
painful visual loss
lasts 1-2weeks
most improve (but not always)
associated with RAPD
what is RAPD
condition in which pupils respond differently to light stimuli shone in one eye at a time
what are sensory Sx of MS
pain paraesthesia numbness trigeminal neuralgia dorsal column loss
what is lost in dorsal column damage
proprioception and vibration loss
what are cerebellar dysfunction Sx
DANISH
- Dysdiadokinesis
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
what are Sx of brain stem dysfunction
Diplopia = VI palsy
Facial weakness = VII palsy
what ophthalmic condition is almost seen exclusively in MS
Internuclear ophthalmoplegia
what is Internuclear ophthalmoplegia
caused by injury/dysfunction in the Medial longitudinal fasciculus
what are Sx of Internuclear ophthalmoplegia
Distortion of binocular vision
Failure of adduction- diplopia
Nystagmus in abducting eye
Lag
what are Sx of lower urinary tract dysfunction in MS
frequency nocturia urgency urge incontinence retention
what could Sx of lower urinary tract dysfunction in MS be confused with
BPH
what is used to treat fatigue in MS
amantadine
what is needed for a diagnosis of MS
At least 2 episodes suggestive of demyelination
Dissemination in time and place
what would Ddx be in MS
Vasculitis
Granulomatous disorder e.g. sarcoidosis
Vascular disease e.g. stroke
Structural lesion e.g. mass pressing on spinal cord
Infection
Metabolic disorder e.g. folate deficiency
what is the most sensitive test for MS
MRI
why are blood tests done in suspected MS
don’t rule in MS but they rule out other differentials
what blood tests should be done, and come back negative, to ensure it is MS
Plasma viscosity, FBC, CRP
Renal liver bone profile
Auto anti body screen - should be normal in MS
Borellia (lime disease), HIV, syphilis serology
B12 and folate
what in the CSF suggests inflammation
oligoclonal bands of IgG on electrophoresis
