Multiple sclerosis Flashcards
what are visual features found in MS?
optic neuritis
optic atrophy
internuclear ophthalmoplegia: affected eye unable to adduct - nystagmus in abducting eye
uhthoff’s phenomenon
- worsening of vision following a rise in body temperature
what is 1st line treatment of an acute attack ?
IV methylprednisolone (up to 5 days)
what is 1st line disease modifying treatment?
beta-interferon
what is the criteria for use of beta-interferon?
relapsing remitting disease + 2 relapses in past 2 years + able to walk 100m
secondary progressive disease + 2 relapses in past 2 years + able/unable to walk 100m
what treatment would you give for a refractory acute attack not responding to prednisolone ?
plasma exchange
what is 1st line treatment for spasticity?
baclofen or gabapentin
what is 1st line of action is patient has urinary dysfunction ?
bladder scan to assess if there is significant residual volume
- if yes then intermittent self catheterisation
- if no then give anticholinergic
what are good prognostic factors ?
female
optic neuritis at first presentation
few relapses in 1st 5 years
long period between relapses
what are poor prognostic factors ?
male
older age
multifocal symptoms and signs
motor symptoms and signs
differentials of MS ?
adrenoleukodystrophy
neuromyelitis optica spectrum disorder
acute disseminated encephalomyelitis (ADEM)
what are the diagnostic criteria used for MS ?
posers criteria - clinical
McDonalds criteria - MRI
what investigations would you carry out if you suspected MS ?
MRI
LP
visual somatosensory evoked response
features of MS on MRI ?
inflammation - hyperdensity
progressive/chronic - hypo density, atrophy
Dawson fingers - hyperdense lesions perpendicular to corpus collosum
periventricular plaques
features of MS on LP ?
oligoclonal bands in CSF but not serum
increased intrathecal synthesis of IgG
