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Neuroscience > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Define Multiple Sclerosis (MS)?

A

Inflammatory demyelinating disease of the CNS

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2
Q

What are the different types of MS?

A

Relapsing-Remitting MS
Clinically Isolated Syndrome
Primary Progressive MS
Marburg Variant

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3
Q

What is Relapsing-Remitting MS?

A

COMMONEST form

Clinical attacks of demyelination with complete recovery in between attacks

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4
Q

What is Clinically Isolated Syndrome?

A

Single clinical attack of demyelination
The attack in itself doesn’t count as MS
10-50% progress to develop MS

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5
Q

What is Primary Progressive MS?

A

Steady accumulation of disability with NO relapsing-remitting pattenr

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6
Q

What is the Marburg Variant of MS?

A

Severe fulminant variant of MS leading to advanced disability or death within weeks

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7
Q

What is the aetiology of MS?

A

Autoimmune basis with potential environmental trigger in genetically susceptible individuals
Immune-mediated damage to myelin sheaths results in impaired axonal conduction

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8
Q

What are the risk factors of MS?

A

EBV exposure

Prenatal vitamin D levels

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9
Q

What is the epidemiology of MS?

A

UK prevalence: 1/1000
2x as common in FEMALES
Age of presentation: 20-40 yrs

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10
Q

What do the presenting symptoms of MS depend on?

A

Varies depending on the site on inflammation

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11
Q

What is the most common symptoms of MS?

A

Optic Neuritis

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12
Q

What is Optic Neuritis?

A

Unilateral deterioration of visual acuity and colour perception
Pain on eye movement
Common first symptoms of MS

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13
Q

What are the sensory symptoms of MS?

A

Pins and Needles
Numbness
Burning

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14
Q

What are the motor symptoms of MS?

A

Limb weakness
Spasms
Stiffness
Heaviness

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15
Q

What are the autonomic symptoms of MS?

A

Urinary urgency
Hesitancy
Incontinence
Impotence

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16
Q

What are the Psychological symptoms of MS

A

Depression

Psychosis

17
Q

What are the other two main symptoms of MS?

A

Uhthoff’s Sign

Lhermitte’s Sign

18
Q

What is Uhthoff’s Sign?

A

Worsening of neurological symptoms as the body gets overheated from hot weather, exercise, saunas, hot tubs etc.

19
Q

What is Lhermitte’s Sign?

A

An electrical sensation that runs down the back and into the limbs when the neck is flexed

20
Q

What are the general signs of MS?

A

Optic Neuritis
Relative Afferent Pupillary Defect (RAPD)
Internuclear Ophthalmoplegia

21
Q

What are the specific signs we see of Optic Neuritis on physical examiantion?

A

Impaired visual acuity (most common)

Loss of coloured vision

22
Q

What are the specific signs of Internuclear Ophthalmoplegia in MS?

A

Lateral horizontal gaze causes failure of adduction of the contralateral eye
Indicates lesion of the contralateral medial longitudinal fasciculus

23
Q

What do we see if we do Visual Field Testing on a patient with MS?

A 
Central Scotoma (if optic nerve is affected)
Field defects (if optic radiations are affected)
24
Q

What is a Scotoma?

A

A blind spot in the normal visual field

25
Q

What are the sensory signs of MS?

A

Paraesthesia

26
Q

What are the motor signs of MS?

A

UMN signs

27
Q

What are the Cerebellar signs of MS?

A

Limb ataxia (intention tremor, past-pointing, dysmetria)
Dysdiadochokinesia
Ataxis wide-based gait
Scanning speech

28
Q

How do we diagnose MS?

A

McDonald criteria

29
Q

What is the McDonald Criteria for MS?

A

Diagnosis is based on the finding of two or more CNS lesions with corresponding symptoms, separated in time and space

30
Q

What investigations do we do for MS?

A

Lumbar Puncture
MRI (brain, cervical and thoracic spine (with gadolinium))
Evoked potentials

31
Q

Why do we do a Lumbar Puncture for MS?

A

Microscopy - exclude infection/inflammatory causes

CSF electrophoresis shows unmatched oligoclonal bands

32
Q

Why do we do a MRI for MS?

A

Plaques can be identified

Gadolinium enhancement shows active lesions

33
Q

Why do we do Evoked Potentials for MS?

A

Visual, auditory and somatosensory evoked potentials may show delayed conduction velocity

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