Multiple Sclerosis Flashcards
An autoimmune disorder that causes segmental demyelination of neurons in CNS
Multiple Sclerosis
The cardinal sign of MS
Charcot’s Triad
Charcot’s Triad
SIN: Scanning speech, Intention tremor, Nystagmus
Etiology of MS
Idiopathic
6 Risk factors of MS
Female, 20-40 years old, Geographical pattern, Family History, Smoking, Vitamin D Deficiency
Hallmark of MS
Multifocal Plaque Formation
Oligodendrocytes ratio
1:60
What imaging is used to detect Multifocal Plaque Formation?
MRI
Criteria used to confirm MS
Mcdonald’s Criteria
Mcdonald’s Criteria: 2 plaques
Clinically definite
Mcdonald’s Criteria: 1 attack
Clinically possible
Mcdonald’s Criteria: 1 or 2 plaques
Clinically probable
Mcdonald’s Criteria: 1 or 2 attack
Clinically probable
Mcdonald’s Criteria: 1 plaque
Clinically possible
Mcdonald’s Criteria: 2 attack
Clinically definite
Distinct pathologic pattern: Apoptosis of oligodendrocytes
Type 3
Distinct pathologic pattern: Cell-mediated destruction of myelin sheath by T-cells
Type 1
Distinct pathologic pattern: Primary degeneration of oligodendrocytes
Type 4
Distinct pathologic pattern: Cell-mediated destruction of myelin sheath by T-cells and Immunoglobulins
Type 2
What distinct pathologic pattern has a (+) repair of oligodendrocytes
Type 1 and 2
What is the most common distinct pathologic pattern of MS?
Type 2: Cell-mediated destruction of myelin sheath by T-cells and Immunoglobulins
What is the least common distinct pathologic pattern of MS?
Type 4: Primary degeneration of oligodendrocytes
Medications that are given in patients with MS
Immuno-regulator medications: Interferon B
Four medications under Interferon B
Betaseron, Extavia, Avonex, Rebif
Medication given during acute MS
Corticosteroid
MS sites of Predilection
POB CCCC: Periventricular white matter, Optic Nerve, Brainstem, Cortex, Cerebellum, Cervical SC (posterior white column)
What ST is present in MS?
Lhermitte Sign
Five clinical types of MS
Relapsing-Remitting, Secondary-Progressive, Primary-Progressive, Progressive-Relapsing, Fulminant
Progressive disease with little to no attacks
PPMS: Primary Progressive MS
Rapid progressive disease with series of attacks later in the course
Fulminant MS
Progressive disease with series of attacks later in the course
PRMS: Progressive Relapsing MS
Clinical type due to the patient not following prescribed intake of medicines
SPMS: Secondary Progressive MS
Exacerbating-remitting MS
RRMS: Relapsing Remitting MS
What is the onset symptoms of RRMS?
Sensory: paresthesia and optic neuritis
Poor prognosticating indicator of MS
Male, Motor onset, older onset, polysymptomatic onset, fewer MRI lesion
Most common clinical type of MS
RRMS
Least common clinical type of MS
PRMS
Percentage of RRMS
85%
Percentage of SPSM
20%
Percentage of PPMS
10%
Percentage of PRMS
5%
7 functional system affected in MS
Visual system, Pyramidal system, Sensory system, Cerebellar system, Brainstem, Mental System, Bowel/Bladder system
Four clinical manifestation under visual system
Optic Neuritis, Nystagmus, Visual Scotoma, Diplopia/Ophthalmoplegia
Ice pick like sensation behind eye with graying/blurring of vision that may lead to blindness
Optic Neuritis
(+) Dark spots in the visual field
Visual Scotoma
What extremity is most commonly affected in MS?
LE
Most common, disabling symptom of MS
Fatigue
Pseudo-exacerbation of symptoms due to increase body temperature
Uthoff’s phenomenon
Fatigue exacerbates due to _____?
Worst in hot temperature
Pseudo-exacerbation of Uthoff’s phenomenon is reversible after what time?
<24 hours
Most common presenting symptoms of MS
Paresthesia
Description of Paresthesia felt by MS
Electric-like sensation
What paresthesia felt in the face?
Trigeminal Neuralgia / Tic Doulourex / Paroxysmal Pain Syndrome
What paresthesia felt in the limb?
Paroxysmal Limb Pain / Dysesthetic Limb
What paresthesia felt in the trunk?
MS Hug
One of the most common pain complaint of patient’s with MS
Headache
Hypersensitivity to light stimulus
Hyperpathia
Painful band sensation around trunk
MS Hug
Most common type of pain felt in MS
Paroxysmal Limb Pain / Dysesthetic Limb
Five cerebellar ataxia seen in MS
Dysmetria, Dyssynergia, Dysdiadochokinesia, Intention Tremor, Gait Ataxia
Description of gait ataxia
Drunkeness
Cranial nerves affected in brainstem
CN 2,5,7,8
Most common speech problem seen in MS with description as problem with controlling the volume
Scanning speech
Three mental status manifestation of MS
Dementia, Attention deficit, Memory loss
Most common bowel problem in MS
Constipation
Most common bladder problem in MS
Detrussor Hyperflexia
Four female sexual problems in MS
Decrease sensation, Loss of Libido, Vaginal Dryness, Difficulty in reaching orgasm
Four male sexual problems in MS
Decrease sensation, Loss of Libido, Difficulty in ejaculation, Impotence
Scale used to classify MS functional activity
Kurtzke Expanded Disability scale
Kurtzke: No disability
1, 1.5
Kurtzke: Fully ambulating without rest and assistance
4, 4.5, 5, 5.5
Kurtzke: Bed bound
8, 8.5
Kurtzke: Moderate disability
3, 3.5
Kurtzke: Intermittent unilateral assistance 100m
6
Kurtzke: Death
10
Kurtzke: Normal
0
Kurtzke: Bed ridden
9, 9.5
Kurtzke: Moderate d/a 1 functional system
3
Kurtzke: No d/a minimal sign in 2 functional system
1
Kurtzke: Constant bilateral assistance 20m
6.5
Kurtzke: Cannot walk beyond 5m
7
Kurtzke: Minimal disability in 2 functional system
2.5
Kurtzke: Unable to take few more steps
7.5
Kurtzke: 500m
4
Kurtzke: 100m
5.5
Kurtzke: cannot eat, talk, swallow
9.5
Kurtzke: can be out of bed
6
Kurtzke: 200m
5
Kurtzke: bed bound much of the day
8.5
Kurtzke: can eat, talk, swallo
9
Kurtzke: 300m
4.5
Score for benign MS
<3
Score of Malignant MS
3 or more
Another name of malignant MS
Marburg Disease
