Multiple sclerosis

Question 1

freatures?

Answer 1

onset at age 15-50, optic neuritis, lhermitte sign, internuclear ophthalmoplegia, fatigue, uhthoff phenomenon (heat sensitivity), sensory symptoms ( numbness and paresthesia), motor symptoms (paraparesis and spasticity), bowel/bladder dysfunction.

Question 2

disease pattern

Answer 2

relapsing-remitting (majority), primary progressive, secondary progressive, progressive relapsing.

Question 3

diagnosis?

Answer 3

T2 MRI lesions disseminated in time and space (periventricular, juxtacortical, infracortical, or spinal cord) hand clumsiness, ataxia, vertigo.
oligoclonal IgG bands on CSF analysis.

Question 4

MS presentation?

Answer 4

neurologic deficits disseminated in space and time ( ex: trigeminal neuralgia, spastic lower-limb paralysis, left upper limb sensory loss).

Question 5

if MS is suspected?

Answer 5

clinical examination and MRI aren’t classic, LP should be performed for CSF analysis, shows oligoclonal bands in 85- 95 %of pt. CSF usually shows a normal cell count with T lymphocyte predominance, there is also a normal protein concentration with immunoglobulins levels being high relative to other proteins (especially IgG). the opening pressure and CSF appearance are usually normal.

Question 6

Pronator drift?

Answer 6

is a physical examination finding that is relatively sensitive and specific for an upper motor neuron or pyramidal/corticospinal tract disease. particularly useful in patients with subtle deficits as it can accentuate pyramidal motor weakness.

Question 7

pronator drift test?

Answer 7

performed by having the patient outstretch their arms with the palms up and eyes closed ( so that only proprioception is used to maintain arm position). Upper motor neuron lesions cause weakness in the supinator muscles compared to the pronator muscles of the upper limb. as a result, the affected arm drifts downward and the palm turns (pronates) towards the floor.