Multiple Sclerosis

Question 1

Risk Factors

Answer 1

Vitamin D def
Smoking
Fam Hx
Obesity

Question 2

Symptoms/Signs

Answer 2

Loss if balance, unsteadiness, clumsiness
Visual: Diplopia, pain on mov, general pain, hemianopia.
Ascending altered sensation/weakness of limbs
Altered sensation descending down back.
Transverse myelitis (bilateral limb paralysis, loss of bowel/bladder functions)

Question 3

Investigations

Answer 3

Bloods:
FBC, UE, LFT, calcium, Glucose, SLE screen, B12 folate.

Imaging:
MRI head (paraventricular lesions), electrophysiology shows demyelination of oligodendrocytes.
Cerebrospinal fluid will have increase in oligoclonal bands of IgG.

Question 4

Management

Answer 4

General Maintenance:
Speech therapist, physio for pain, OT.
Specialist care with nurse, consultant with annual followups with GP.
Prescription of Dimethyl-fumarate

Relapse:
Progression of symptoms over 12-24 hours. Admit for assessment by specialist who will determine if steroids IV or oral needed.

Gabapentin for spasticity and pain.