Multiple Sclerosis Flashcards
Define Multiple Sclerosis (MS)?
Inflammatory demyelinating disease of the CNS
What are the different types of MS?
Relapsing-Remitting MS
Clinically Isolated Syndrome
Primary Progressive MS
Marburg Variant
What is Relapsing-Remitting MS?
COMMONEST form
Clinical attacks of demyelination with complete recovery in between attacks
What is Clinically Isolated Syndrome?
Single clinical attack of demyelination
The attack in itself doesn’t count as MS
10-50% progress to develop MS
What is Primary Progressive MS?
Steady accumulation of disability with NO relapsing-remitting pattenr
What is the Marburg Variant of MS?
Severe fulminant variant of MS leading to advanced disability or death within weeks
What is the aetiology of MS?
Autoimmune basis with potential environmental trigger in genetically susceptible individuals
Immune-mediated damage to myelin sheaths results in impaired axonal conduction
What are the risk factors of MS?
EBV exposure
Prenatal vitamin D levels
What is the epidemiology of MS?
UK prevalence: 1/1000
2x as common in FEMALES
Age of presentation: 20-40 yrs
What do the presenting symptoms of MS depend on?
Varies depending on the site on inflammation
What is the most common symptoms of MS?
Optic Neuritis
What is Optic Neuritis?
Unilateral deterioration of visual acuity and colour perception
Pain on eye movement
Common first symptoms of MS
What are the sensory symptoms of MS?
Pins and Needles
Numbness
Burning
What are the motor symptoms of MS?
Limb weakness
Spasms
Stiffness
Heaviness
What are the autonomic symptoms of MS?
Urinary urgency
Hesitancy
Incontinence
Impotence
What are the Psychological symptoms of MS
Depression
Psychosis
What are the other two main symptoms of MS?
Uhthoff’s Sign
Lhermitte’s Sign
What is Uhthoff’s Sign?
Worsening of neurological symptoms as the body gets overheated from hot weather, exercise, saunas, hot tubs etc.
What is Lhermitte’s Sign?
An electrical sensation that runs down the back and into the limbs when the neck is flexed
What are the general signs of MS?
Optic Neuritis
Relative Afferent Pupillary Defect (RAPD)
Internuclear Ophthalmoplegia
What are the specific signs we see of Optic Neuritis on physical examiantion?
Impaired visual acuity (most common)
Loss of coloured vision
What are the specific signs of Internuclear Ophthalmoplegia in MS?
Lateral horizontal gaze causes failure of adduction of the contralateral eye
Indicates lesion of the contralateral medial longitudinal fasciculus
What do we see if we do Visual Field Testing on a patient with MS?
Central Scotoma (if optic nerve is affected) Field defects (if optic radiations are affected)
What is a Scotoma?
A blind spot in the normal visual field
What are the sensory signs of MS?
Paraesthesia
What are the motor signs of MS?
UMN signs
What are the Cerebellar signs of MS?
Limb ataxia (intention tremor, past-pointing, dysmetria)
Dysdiadochokinesia
Ataxis wide-based gait
Scanning speech
How do we diagnose MS?
McDonald criteria
What is the McDonald Criteria for MS?
Diagnosis is based on the finding of two or more CNS lesions with corresponding symptoms, separated in time and space
What investigations do we do for MS?
Lumbar Puncture
MRI (brain, cervical and thoracic spine (with gadolinium))
Evoked potentials
Why do we do a Lumbar Puncture for MS?
Microscopy - exclude infection/inflammatory causes
CSF electrophoresis shows unmatched oligoclonal bands
Why do we do a MRI for MS?
Plaques can be identified
Gadolinium enhancement shows active lesions
Why do we do Evoked Potentials for MS?
Visual, auditory and somatosensory evoked potentials may show delayed conduction velocity
