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Neurology Year 3 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

Inflammatory Demyelinating Disorder

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2
Q

Who is likely to get MS?

A

M:F - 1:3

30-40s

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3
Q

What is the usually pattern of presentation in MS?

A

Relapsing and remitting symptoms present then disappear.

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4
Q

What is the rarest form of MS?

A

Primary - no relapse

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5
Q

List clinical features of MS.

A 
Pyramidal dysfunction 
Optic neuritis
Sensory symptoms 
Cognitive impairment 
Cerebellar dysfunction
Brain stem issues
Urinary incontinence
Fatigue
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6
Q

What pyramidal dysfunction is associated with MS?

A

Increased tone spasticity
Weakness
Flexor and extensor both affected the same.

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7
Q

What occurs in MS related optic neuritis?

A

Painful vision loss for 1-2 week
Most improve
Look for RAPD -Relative Afferent Pupillary Defect

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8
Q

What sensory symptoms are associated with MS?

A 
Pain 
Paraethesia pins and needles
Proprioception and vibration
Numbness
Trigeminal Neuralgia
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9
Q

What cerebellar dysfunction is associated with MS?

A 
Dysarthria 
Ataxia
Nystagmus - involuntary eye movement
Intention tremor
Pendular reflex
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10
Q

What brain stem issues are associated with MS?

A

Diplopia
VI palsy
Facial weakness VII

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11
Q

Why do some patients with MS present with Internuclear opthalmoplegia?

A

Disturbance of binocular vision
Failure of abducens due to VI palsy
Nystagmus in abduction eye

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12
Q

Why do MS patients present with urinary incontinence?

A

Increased tone at bladder neck and hypersensitivity

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13
Q

What is required for a diagnosis of MS?

A

At least 2 episodes suggestive of demyelination and alternative diagnosis excluded.
Either one on MRI and one clinical or both on MRI

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14
Q

What tests are undertaken in a suspected MS patient?

A

MRI CSF Neurophysiology Bloods

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15
Q

What are some differential diagnosis’s in a patient with MS like symptoms?

A 
Vasculitis
Granulomatous
Structural lesions
Infection
Metabolic disorders
B12 deficiency
Folic acid deficiency
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16
Q

What are you looking for in the CSF of someone with MS?

A

Unmatched oligoclonal bands

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17
Q

If someone presents with acute mild MS what is the treatment?

A

Purely symptomatic

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18
Q

If someone presents with acute moderate MS what is the treatment?

A

Oral steroids

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19
Q

If someone presents with acute severe MS what is the treatment?

A

IV steroids and admission

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20
Q

Symptomatic pyramidal dysfunction is treated how?

A

Physiotherapy
Baclofen - spasticity
Tizanidine -spasticity
Botulinum Toxin - spasticity

21
Q

What treatment is given for the sensory symptoms of MS?

A

Anticonvulsant - Gabapentin
Antidepressant - Amitriptyline
Acupuncture
Lignocaine infusion

22
Q

What can be used for the treatment of urinary incompetence?

A

Anticholinergics
Catheterisation
Bladder training

23
Q

What is the first line disease modifying drug?

A

Tecfedira
Aubagia
INFβ IV

24
Q

What are second line disease modifying drugs used in MS?

A

Monoclonal antibodies i.e Lemtrada

Fingolimod

25
Q

When are second line disease modifying drugs used?

A

In either resistant or severe early onset 2 episodes within a year.

26
Q

What are the third line disease modifying drugs?

A

Mitoxantrone

Stem cell transplant

27
Q

When are the third line disease modifying drugs used?

A

Very severe relapsing disease

28
Q

What is Tecfidera ?

A

1st line
Oral agent
44% reduction in symptoms

29
Q

What is INFβ?

A

Interferron β
SC or IM
Decreases rate and severity of relapses
Very few side effects

30
Q

What is Fingolimod?

A

2nd line
Oral agents
Toxicity means not 1st line

31
Q

What are some of the side effects of fingolimod?

A

Cardia toxicity
Lower white cell count
Hypertension

32
Q

List some common monoclonal antibodies.

A

Rituximab

Natlilizumab

33
Q

When is Rituximab used?

A

Highly active relapsing and remitting MS

34
Q

How does Natilizumab work

A

Bings to α4 integrin
Prevents binding of lymphocyte to the VCAM on blood vessel wall
Prevent lymphocyte migration out of the blood vessel.

35
Q

Describe plaques related to MS.

A

Well circumscribed and demarcated with an irregular shape often glassy and translucent.
Massive variation in size

36
Q

What does an active plaque appear like?

A

Perivascular inflammation
Microglia
Ongoing demyelination

37
Q

What does an inactive plaque appear like?

A

Gliosis
Few myelinated axons
Reduced oligodendrocytes

38
Q

What is the association of MS with latitude ?

A

Further from the equator there is an increase in prevalence of MS.

39
Q

What is another primary cause of demyelination which isn’t MS with a low mortality?

A

Acute disseminate Encephalomyelitis

Self limiting, full recovery with some defecits

40
Q

What is another primary cause of demyelination which isn’t MS with a high mortality?

A

Acute haemorrhage leukoencephalitis

41
Q

What is a secondary cause of demyelination?

A

Central pontine myoclinosis

42
Q

What causes Central Pontine myoclinosis?

A

Too fast correction of hyponatraemia

43
Q

What virus can lead to. secondary form of demyelination?

A

JC virus

44
Q

What can lead to a toxic secondary form of demyelination?

A

Organic solvents

45
Q

List some environmental factors related to MS?

A

Vitamin D deficiency

Viral triggers e.g. EBV

46
Q

List some genetic factors related to MS?

A

HLA DRB
Polymorphism in Interleukins
Familial link

47
Q

What interleukins when mutated are linked to an increased risk of MS?

A

IL-2

IL-7

48
Q

What forms the oligoclonal bands found in the CSF of someone with MS?

A

IgG

Neurology Year 3 (29 decks)

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