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Neurology > Multiple Sclerosis and inflammatory CNS disease > Flashcards

Multiple Sclerosis and inflammatory CNS disease Flashcards

1
Q

The F:M ratio for MS is?

A

3:1

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2
Q

What are the clinical features of MS?

A
  • Pyramidal dysfunction
  • Optic neuritis
  • Sensory symptoms
  • Lr urinary tract dysfunction
  • Cerebellar and brain stem features
  • Cognitive impairement
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3
Q

What are the features of pyramidal dysfunction?

A
  • Increased tone
  • spasticity
  • weakness
  • extensors of upper limbs
  • flexors of lower limbs
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4
Q

What is optic neuritis?

A

Painful visual loss
1 to 2 weeks
Most improve

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5
Q

What is a clinical sign of optic neuritis?

A

RAPD

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6
Q

What are the sensory symptoms of MS?

A 
Pain
Paraesthesia
Dorsal column loss
- proprioception and vibration
Numbness 
Trigeminal neuralgia
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7
Q

Describe cerebellar dysfunction in MS?

A 
Dysarthria
Ataxia
Nystagmus
Intention tremor
Past pointing
Pendular reflexes
Dysdiodokineses
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8
Q

What may be seen in brain stem dysfunction?

A

Diplopia

Facial Weakness

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9
Q

What is the clinical presentation of internuclear ophthalmoplegia?

A
  • Distortion of binocular vision
  • Failure of adduction - diplopia
  • Nystagmus in abducting eye
  • Lag
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10
Q

What part of the brainstem causes internuclear ophthalmoplegia

A

Medial longitudinal fasciculus

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11
Q

Describe lower urinary tract dysfunction in MS?

A 
Frequency
Nocturia
Urgency
Urge incontinence
Retention
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12
Q

How can fatigue in MS be managed?

A

Amantadine
Modafinil if sleepy
Hyperbaric oxygen

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13
Q

How is MS diagnosed clinically?

A

At least 2 episodes suggestive of demyelination

Dissemination in time and place

Alternative diagnosis excluded

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14
Q

Which investigations are done for MS?

A

MRI
CSF
Neurophysiology
Blood tests

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15
Q

List some differential diagnoses of MS

A 
Vasculitis
Granulomatous disorder
Vascular disease
Structural lesion
Infection
Metabolic disorder
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16
Q

What is found in CSF?

A

Oligoclonal bands in CSF

17
Q

What are the treatment options for spasticity?

A 
Physiotherapy
Oral medication
- baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/phenol
18
Q

What are the options for sensory symptoms of MS?

A

Anti convulsant e.g. gabapentin

Anti depressant e.g.amitriptyline

Tens machine
Acupuncture
Lignocaine infusion

19
Q

Describe urinary dysfunction in MS?

A
  • Increased tone at bladder neck
  • Detruser hypersensitivity
  • Detruser sphyncteric dyssenergia
20
Q

What are the treatment options for Lr urinary tract dysfunction in MS?

A

Bladder drill

Anti cholinergic e.g. oxybutynin

Desmopressin

Catheterisation

21
Q

What is the first line disease modifying therapy?

A
  • Interferon beta- Avonex, rebif, Betaseron, extavia
  • Glitiramer acetate
  • Tecfedira, aubagio
22
Q

What is the second line disease modifying therapy?

A
  • Monoclonal antibody- tysabri, ocrevus

- Fingolimod, cladrabine

23
Q

What is the third line disease modifying therapy?

A

Mitoxantrone, lemtrada

HSCT (stem cell transplantation)

24
Q

Interferons & glitiramer acetate are ________ agents (__,__)
They decrease relapse rate by / and decrease the severity of relapses by __%

A

Interferons & glitiramer acetate are injectable agents (sc,im)
They decrease relapse rate by 1/3 and decrease the severity of relapses by 50%

25
Q

Tecfidera is an ____ agent, it is the first line agent in __ __. It confers a __% reduction in relapse rate

A

Tecfidera is an oral agent, it is the first line agent in RR MS. It confers a 60% reduction in relapse rate

26
Q

Fingolimod and cadrabine are ____ agents, they confer a >__% reduction on relapse rate

A

Fingolimod and cadrabine are oral agents, they confer a >50% reduction on relapse rate

27
Q

Who is eligible for treatment with tysabri?

A

Patients with rapidly evolving severe relapsing remitting MS

Patients with high disease activity despite treatment with alpha interferon

28
Q

Trans-endotherlial migration of activated T-cells across ___ in EAE mediated by _______

A

Trans-endotherlial migration of activated T-cells across BBB in EAE mediated by integrins

29
Q

Describe the inflammatory cascade in MS?

A
  1. immune cells pass through blood-brain barrier
  2. immune cells may re-activate and produce cytokines
  3. immune cells mount attack against myelin

Neurology (41 decks)

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