Brainscape's Knowledge GenomeTM

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


See full index

Neuro > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Chronic, immune mediated ,inflammatory condition of the central nervous system

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

The CNS is comprised of..

A

The brain
Brainstem
Spinal cord

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

Which group of patients is MS most commonly seen in?

A

Young people

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

What is the pathological hallmark of multiple sclerosis?

A

Demyelination

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

What is demyelination?

A

Damage to the myelin sheath surrounding neurons

Leads to scarring and secondary neuronal cell loss - irreversible neurological damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the typical course of MS

A

Relapsing-remitting
Unpredictable in individuals
Progressive disability

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

Mean age of onset of MS

A

30 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aetiology of MS

A

Unknown- abnormal immune reaction to unknown environmental trigger in genetically predisposed individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Concordance of MS in twins

A

20-35% in monozygotic twins

Dizygotic 5%

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

Risk factors for MS

A 
Genetics
Infection - EBV
Geographic latitude - more common further from equator; risk changes at 10 years old
Sunlight exposure - inverse relationship
Obesity during adolescence
Smoking
Female
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What cell is responsible for producing the myelin sheath and are destroyed in MS?

A

Oligodendrocytes

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

What type of cells are oligodendrocytes?

A

Glial cells - support neurons

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

Pathological process of MS

A

Activation of myelin reactive T lymphocytes
Disruption of BBB
Pro-inflammatory response and cell recruitment in CNS
- B cells, microglia, macrophages
Antibody-mediated response
MS plaques with myelin reactive T cells, B cells and macrophages
Inflammation, scarring and axonal injury (loss)
Clinical manifestation depends on location of plaques

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

What are microglia?

A

Macrophages of CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Classic plaque sites in MS

A 
Optic nerves
Spinal cord
Brainstem
Cerebellum
Juxtacortical white matter
Periventricular white matter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What plaque site gives rise to the most common presenting symptom for MS?

A

Optic nerve - vision blurry.
Optic atrohpy - optic disc pale and small
Examine fundi
Patient may be unaware they had optic neuritis

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

What presenting symptom can indicate an MS plaque in the brainstem?

A

Opthalmaplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a relapse in MS?

A

Episode of exacerbation of symptoms followed by period of remission in 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Do symptoms resolve in remission phase of relapsing-remitting course of MS?

A

Sometimes

As disease progresses patient may be left with residual damage from relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is primary progressive MS?

A

PPMS
Subtype in 10-15%
Sustained rogression of disease severity from onset
May have periods where disease is not active or non-progressive but no evidence of remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is secondary progressive MS?

A

Developed by 50% of patients with relapsing remitting MS after 15 years of onset
Disease course changes with gradual worsening of neurological function. Relapses may still occur but not remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Clinically Isolated Syndrome (CIS) - MS?

A

Describes first clinical episode of MS
No previous evidence of demyelination clinically or on imaging
Oligoclonal bands in CSF may be used to support diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Three characteristic clinical features of MS

A

Optic neuritis
Lhermitte phenomenon
Internuclear opthalmoplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is lhermitte phenomenon?

A

Uncomfortable electric shock sensation triggered by neck flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs of internuclear opthalmoplegia (INO)?

A

Ask patient to look left

  • left eye nystagmus
  • right eye cannot adduct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which part of the brainstem is susceptible to demyelination and will result in INO?

A

Pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Other symptoms of MS common to neurological conditions

A

Motor weakness
Diplopia
Gait disturbance
Bladder/bowel dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Four groups of clinical manifestations of MS

A

Visual
Motor and coordination
Sensory and autonomic
Cognitive and psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is optic neuritis?

A

Inflammation of the optic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Presenting features of optic neuritis

A 
Blurred vision
Visual loss
Pain - behind eye and on movement
Scotoma - partial field loss
Poor colour differentiation
Relative afferent pupillary defect
Optic nerve swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Eye movement disorders typically occur due to lesions of…

A

The brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which two common eye movement disorders are caused by brainstem lesions?

A

Abducens palsy

Internuclear opthalmoplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Demyelination of which tract leads to INO?

A

Medial longitudinal fasciculus

34
Q

What does the medial longitudinal fasciculus connect?

A

Abducens nucleus complex with contralateral oculomotor complex

35
Q

In INO if looking to the right, what are the signs in each eye?

A

Right will abduct, left will remain central

36
Q

In abducens palsy what happens in right eye when looking to the right if the right abducens nerve is affected?

A

Remains central - cannot abduct

37
Q

What is the prominent motor feature in MS?

A

Progressive paraparesis and upper motor neuron signs

38
Q

What are upper motor neuron signs?

A

Spasticity
Hyperreflexia
Reduced power

39
Q

Motor and coordination abnormalities in MS may present as which syndrome?

A

Typcial clinical syndrome

40
Q

Which 2 conditions are included in typical clinical syndrome (MS)?

A

Transverse myelitis

Cerebellar syndrome

41
Q

What is transverse myelitis?

A

Focal inflammation within the spine
Sensory and motor symptoms below level of lesion
Can have bladder/bowel involvement
Usually sensory level corresponding to the lesion

42
Q

What must be excluded in diagnosis of transverse myelitis?

A

Compressive pathology eg metastatic cord compression

43
Q

Cerebellar syndrome - symptoms

A 
Ataxia
Slurred speech
Intention tremor
Nystagmus
Vertigo
clumsiness
44
Q

Sensory and autonomic symptoms of MS

A 
Paraesthesia
Pain
Heat sensitivity (Uhthoff phenomenon)
Sexual dysfunction
Bladder & bowel dysfunction
45
Q

What is the Uhthoff phenomenon?

A

Heat sensitivity - MS

46
Q

Cognitive and psychological manifestations of MS

A

Cognitive impairment
Fatigue
Depression
Memory, attention, concentration

47
Q

How is MS diagnosed?

A

Primarily clinical - MS attack

Supported by MRI images of scarring or lesions

48
Q

What is an MS attack?

A

an episode of neurological symptoms that relate to an inflammatory demyelinating lesion.
Lasts > 24 hours with or without recovery.
Typically sensory disturbances, motor weakness, or visual complaints.

49
Q

How many days must be between MS attacks to count as a separate episode?

A

More than 30 days

50
Q

Which criteria is used in the diagnosis of MS?

A

McDonald Criteria

51
Q

Principle of the MacDonald criteria

A

Demyelinating lesions are disseminated in time and space
2 attacks - disseminated in time
2 lesions - disseminated in space

52
Q

MacDonald criteria for diagnosis of MS

A

≥2 attacks with objective clinical evidence of ≥2 lesions: MS diagnosed
≥2 attacks but objective clinical evidence for only one lesion: evidence of dissemination in time, but not space. MS diagnosed if dissemination in space shown on MRI or subsequent clinical attack representing new area.
Single attack with objective clinical evidence of one lesion: clinically isolated syndrome. MS diagnosed once proof of both dissemination in time and space.
Single attack with objective clinical evidence of ≥2 lesions: clinically isolated syndrome. MS diagnosed once proof of dissemination in time.

53
Q

Which scan can be used in correlation with the MRI to diagnose MS?

A

MRI may be used to show dissemination in time by the simultaneous presence of gadolinium-enhancing and nonenhancing lesions at any time, or by a new gadolinium-enhancing lesion(s) on follow-up MRI

Show active lesions, and older lesions

54
Q

Differentials to MS

A 
Infection
Other demyelinating conditions
Malignancy
Metabolic disorder
Systemic inflammatory conditions - SLE, sarcoidosis
55
Q

Condition with similar phenotype to MS

A

Devic’s - Neuromyelitis optica

Neuromyelitis optica spectrum disorders

56
Q

Hallmark of neuromyelitis optica spectrum disorders

A

Acute attack of bilateral optic neuritis or transverse myelitis

57
Q

How does NMOSD differ to MS?

A

Conditions similar presentation but more severe in NMOSD

58
Q

What antibody is formed in neuromyelitis optica spectrum disorder?

A

IgG autoantibody to aquaporin 4 (AQP4)

59
Q

Treatment of NMOSD

A

Corticosteroids

Plasma exchange for refractory cases

60
Q

Investigations for MS

A

Bloods
Oligoclonal bands on CSF
Visual Evoked Response
Antibody testing

61
Q

Which blood tests are required in diagnosis of MS?

A 
FBC
CRP/ESR
LFTs, U&Es, Bone profile (calcium)
Glucose, HbA1c
TFTs
Haematinics
HIV test
62
Q

How is CSF sample acquired and what sample is required alongside CSF to confirm MS diagnosis?

A

Lumbar puncture
Serum sample
Oligoclonal bands must be absent in serum, present in CSF

63
Q

Which conditon is diagnosed by identical oligoclonal bands in both the CSF and serum?

A

Rheumatoid arthritis

64
Q

What does the visual evoked response involve in diagnosis of MS?

A

Electrical activity measured over the occipital cortex in response to light
Assesses evidence of previous asymptomatic episodes of optic neuritis
Up to 90% of individuals will have a persistent abnormality on VER following an acute episode at one year.

65
Q

Which 2 antibodies are common to NMOSD and can exclude MS as diagnosis?

A

Both AQP4 and myelin oligodendrocyte glycoprotein (MOG) antibodies are associated with NMOSD.

66
Q

Three categories of MS management to consider

A

General care
Acute relapses
Disease modifying treatment

67
Q

Symptoms targeted in MS treatment

A 
Bladder dysfunction
Depression
Fatigue
Spasticity
Poor motor function
68
Q

How is bladder dysfunction treated in the general management of MS

A

Anticholinergics - oxybutynin for detrusor overactivity
Botulism injection
Catheter for urinary retention

69
Q

How is bowel dysfunction treated in the general management of MS

A

(Constipation, poor evacuation and incontinence)
Dietary changes
Laxatives
Enema

70
Q

How is depression treated in the general management of MS

A

SSRIs

Duloxetine may be used if co-existing neuropathic pain or fatigue

71
Q

How is fatigue treated in the general management of MS

A

Non-pharmacological eg physical activity
Treat depression
Pharm - modafinil

72
Q

How is gait impairment treated in the general management of MS

A

OT
Physio
Walking aids, wheelchair

73
Q

How is pain treated in the general management of MS

A

Amitriptyline , Gabapentin, Pregabilin

74
Q

How is spasticity treated in the general management of MS

A

Physio
Baclofen
Botulism

75
Q

Treatment of acute relapse of MS

A

Steroids: oral methylprednisolone 0.5 g daily for five days, OR Intravenous methylprednisolone 1 g daily for 3-5 days
Gastroprotection: proton pump inhibitor
Discuss risk/benefit of treatment: particular attention to acute changes in blood glucose and mental health

76
Q

When can recovery from acute relapse be expected after treatment?

A

2-3 months in most cases

May be residual functional disabilities

77
Q

Aim of disease modifying therapies in MS

A

Decrease relapse frequency and slow progression

78
Q

Two criteria for initiating DMT in MS

A

No evidence of non-relapsing progressive MS
Sustained disability due to MS: measured on Expanded Disability Status Scale (EDSS). Score should be < 7.0 (i.e. at least ambulant with two crutches).

79
Q

Examples of DMTs in MS

A 
Interferon beta
Glatiramer acetate
Teriflunomide
Alemtuzumab
Cladribine
Natalizumab
80
Q

Median time of PPMS and requiring a walking aid

A

8 years

81
Q

Factors linked to prognosis in MS

A

Disease type: RRMS better prognosis than PPMS. Most patients with RRMS eventually develop SPMS.
Recovery following first attack: incomplete recovery associated with worse prognosis
Clinical manifestations at onset: pyramidal, brainstem, and cerebellar symptoms (poor prognosis). Sensory symptoms, optic neuritis (favourable prognosis).
Pregnancy: protective during pregnancy. Increased risk of relapse in postpartum period.
Imaging: lesion load and cerebral atrophy linked to prognosis (higher burden and increased atrophy have worse prognosis).

82
Q

Which disease type of MS has better prognosis?

A

Relapsing remitting MS

Neuro (9 decks)

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