Multiple Sclerosis Flashcards
Define multiple sclerosis
Inflammatory demyelinating disease of the CNS characterised by episodic neurological
dysfunction in >2 areas of the CNS separated in space and time
• Relapsing-remitting – clinical attacks with complete recovery in between
• Secondary progressive – relapsing-remitting -> progressive
• Primary progressive – progressive at onset
What are the causes/risk factors of multiple sclerosis?
Unknown aetiology
What are the symptoms of multiple sclerosis?
- Sx worsen with hot showers
- Fatigue
Optic neuritis
• Unilateral deterioration in visual
acuity and colour perception
• Pain on eye movement
Sensory • Paraesthesia • Numbness • Tingling • Burning
Motor • Limb weakness • Spasms • Stiffness • Heaviness
Autonomic • Urinary urgency • Hesitancy • Incontinence • Impotence
Psychological
• Depression
• Psychosis
What are the signs of multiple sclerosis?
Eyes • Loss of visual acuity • Loss of colour vision • Central scotoma • Visual field defects • RAPD • Acute: swollen optic nerve • Chronic: optic atrophy • Internuclear ophthalmoplegia (lesion of contralateral MLF)
Sensory
• Loss of vibration and
proprioception
Motor
• Spastic weakness
• Brisk reflexes
Cerebellar • Dysdiadochokinesis • Ataxic wide based gait • Intention tremor • Scanning speech • Past-pointing/dysmetria
What investigations are carried out for multiple sclerosis?
• Lumbar Puncture - lucose, protein, and cell count should be normal.
- Oligoclonal bands and elevated CSF immunoglobulin G (IgG) and IgG synthesis rates are present in 80% of MS cases
• MRI Brain/ Spine - plaque detection is highlighted as high-signal lesions. Gadolinium enhancement indicates an active lesion. You would expect therefore darker plaques – older lesions and new plaques brighter lesions. There fore there is dissemination in space and time which is needed for diagnosis of MS.
• Evoked Potential - visual, auditory or somatosensory evoked potentials (VEP, BEP, SEP) may show delayed conduction velocity. VEPs are delayed in 90% of patients with MS.
• Enchanced MRI – inflame, break down BBB, GAD penetrate. Scan can show 2 different attacks in different locations. You can also look at the clonal bands – unmatched in CSF and Serum. You want the IG bands to be in the CSF but not blood. So there is an inflammatory response in the CSF. Nerve conduction studies and evoked potentials also looked into
