Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is Multiple Sclerosis?

A

Auto-immune demyelinating disorder characterised by distinct episodes of neurological deficit separated in time and in foci of neurological injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What factors predispose to MS?

A

Genetics (HLA DRB)
Environmental (viral, latitude vitamin D)
Immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define MS plaques

A

Well circumscribed, well demarcated irregular shaped areas that have glassy translucent appearance and vary in size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which part of the brain does demyelination tend to occur?

A

White matter where myelinated axons are concentrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where in the white matter do lesions frequently occur?

A 
Adjacent to lateral ventricles 
Corpus callosum 
Optic nerves and chiasm 
Brainstem 
Ascending and descending tracts 
Cerebellum 
Spinal cord 
Second cranial nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

On MRI what do the plaques look like?

A

Hyperintense white matter lesions

Atrophy in later stages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the histology of active plaques

A
  • perivascular inflammatory cells in a cuff shape
  • microglia
  • ongoing demyelination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the histology of inactive plaques

A
  • gliosis
  • little remaining myelinated axons
  • oligodendrocytes and axons reduced in number
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the macroscopic appearance of active plaques

A

Yellow/brown in colour due to lipid debris, ill defined edge which blends into the surrounding white matter, centred around small vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the macroscopic appearance of inactive plaques

A

Well demarcated grey/brown lesions in white matter, classically situated around lateral ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are shadow plaques?

A

May reflect a degree of re-myelination and demonstrate thinned out myelin sheaths at the edge of lesions, results in a well defined lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the immune pathogenesis of MS?

A

Cell mediated immunity - T cell factors cross BBB and by release of cytokines target myelin and activate B cells to produce antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can be seen in the CSF of almost all MS patients?

A

Oligoclonal IgG bands not in plasma

May have increased white cell count too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name four types of MS

A
  • relapsing remitting
  • secondary progressive
  • progressive relapsing
  • primary progressive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is meant by relapsing remitting MS?

A

Patients usually present with an optic neuritis or sensory problem. Periods of good symptom control and periods of relapse. Slowly evolves to secondary progressive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe secondary progressive MS

A

Slowly gets worse over time and some continue to have relapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is primary progressive MS?

A

No periods of relapse, gets worse fairly quickly

18
Q

State the clinical features of MS

A 
Pyramidal dysfunction 
Optic neuritis 
Sensory symptoms 
Urinary Tract dysfunction 
Cerebellar and brain stem function abnormality 
Cognitive impairment 
Internuclear ophthalmoplegia 
Fatigue
19
Q

How does pyramidal dysfunction present?

A

Weakness, spasticity in extensors of the upper limb and flexors of the lower limb, increased tone

20
Q

What are the ocular manifestation of MS?

A

Optic neuritis - visual loss, RAPD, most improve with time
Internuclear ophthalmoplegia - medial longitudinal fasciculus distortion of binocularity, failure to adduct, nystagmus on abduction and lag

21
Q

Name the sensory symptoms experienced in MS

A

Pain, paraesthesia, dorsal column loss, numbness, trigeminal neuralgia

22
Q

What cerebellar function abnormalities can occur due to MS?

A

Dysarthria, ataxia, tremor, nystagmus, penduncular reflexes, past pointing, dysdiadokinesis

23
Q

What brain stem abnormalities can occur with MS?

A 
Diplopia (CN VI)
Facial weakness (CN VII)
24
Q

State the urinary symptoms MS patients may experience

A

Frequency, nocturia, urgency, incontinence, retention, increased tone, detrusor hypersensitivity leading to detrusor sphynetric dysenergia

25
Q

How is MS diagnosed?

A

2 episodes suggestive of demyelination, disseminated in time and place - exclude other causes

26
Q

What investigations are carried out on a patient with suspected MS?

A

MRI
CSF
Neurophysiology
Blood tests

27
Q

Which blood tests should be done in MS?

A 
Plasma viscocity, CRP, FBC 
Renal, liver bone profile 
Auto-antibody screen
Infection screen 
B12/folate/VitD
28
Q

How are acute exacerbations of MS managed?

A

Mild - symptomatic treatment
Moderate - oral steroids (methlyprednisolone 5 days)
Severe - admission for IV steroids

29
Q

What treatment can be given for pyramidal dysfunction?

A

Physio/OT, anti-spasmodic baclofen or tizanidine, botox, intrathecal baclofen/phenol in very severe cases

30
Q

How can sensory symptoms be managed?

A

Anti-convulsant (gabapentin)
Anti-depressant (amitriptyline)
Tens machine or acupuncture
Lignocaine infusion if resistant to other treatment

31
Q

How can urinary dysfunction be managed?

A

Bladder training
Anti- cholinergic - oxybutin
Desmopressin for long journeys
Catheterisation

32
Q

What is the first line disease modifying therapy?

A

Tecfedira or Aubagio
Interferon beta
Glibramer Acetate
For relapsing remitting MS with modest disability

33
Q

What is second line disease modifying therapy?

A

Monoclonal antibody
Figolimod, Cladrabine
For unsuccessful first line or severe first presentation

34
Q

What is classed as a severe presentation?

A

2 or more attacks in one year

35
Q

What is third line disease modifying therapy?

A

Stem cell transplantation in very extreme cases

36
Q

Give an example of a mono-clonal antibody treatment

A

Anti-integrin (natilizumab)

37
Q

Describe the mode of action of natilizumab

A

Prevents binding of VCAM to inhibit lymphocyte transportation across the BBB and modulates lymphocytic apoptosis

38
Q

How often is natilizumab given?

A

Monthly as an infusion

39
Q

What is the risk of natilizumab?

A

JC virus can reactivate and cause PML

40
Q

What treatment is not licensed but can significantly improve symptoms in MS?

A

Cannabis Sativa

Neurology (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions