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Neurology SOH > Multiple Sclerosis (MS) > Flashcards

Multiple Sclerosis (MS) Flashcards

1
Q

Definition

A

Autoimmune inflammatory disorder

Demyelination of the CNS (brain + SC)

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2
Q

There is damage to ????

A

Myelin sheath

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3
Q

More common in males/females

A

Females

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4
Q

Which age does it usually present around?

A

Age 20-40

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5
Q

Causes - environmental

A

Association with high latitude

Relationship with vitamin D deficiency

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6
Q

Causes - genetics

A

HLA DRB1

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7
Q

MS is an unpredictable condition. True or false?

A

True

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8
Q

There are a variety of clinical courses. What is the most common clinical course?

A

Relapsing remitting

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9
Q

Name the 4 main clinical courses

A

Relapsing remitting
Primary progressive
Progressive relapsing
Secondary progressive

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10
Q

Which clinical course is most disabling?

A

Relapsing remitting

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11
Q

Which type of cell is damaged ?

A

Oligodendrocyte damage

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12
Q

Oligodendrocyte damage causes what?

A

Disrupts neuronal conduction and results in demyelination. There is limited capacity to remyelinate after damage

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13
Q

Demyelination

A

Characterised by defects in the rate and consistency or neuronal conduction
Preferential damage to the myelin sheath
Relative preservation of axons

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14
Q

MS is principally a grey/white matter disease ? and why?

A

White matter disease

- myelinated axons are concentrated at white matter

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15
Q

Exterior surface of the brain typically appears normal/abnormal?

A

Normal

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16
Q

Cut surface of the brain shows which abnormality?

A

Plaques

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17
Q

Plaques in MS

A

Well demarcated
Irregular shaped areas
Glassy almost translucent appearance
Vary from very small to very large lesions

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18
Q

Where are plaques located

A

Can occur at any site in the CNS but most common locations are

  • adjacent to lateral ventricles
  • corpus callosum
  • optic nerves and chiasm
  • brainstem
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19
Q

Plaques tend to be distributed in a symmetrical manner. True or false?

A

False

- non-symmetrical

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20
Q

What are the 2 types of plaque

A

Active (acute) plaque

Inactive (chronic) plaque

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21
Q

Active (acute) plaque

A

Shows active inflammation and ongoing demyelination

Abundant microglia

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22
Q

Active (acute) plaque - macroscopic appearance

A

Demyelinating plaques are yellow/brown with an ill defined edge which blends into surrounding white matter

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23
Q

Inactive (chronic) plaque

A

Inflammation dampens down
Predominated by scarring
Little remaining myelinated axons

24
Q

Inactive (chronic) plaque - macroscopic appearance

A

Well demarcated grey/brown lesions in with matter, classically situated around the lateral ventricles

25
Q

Inflammatory cascade

A

Immune cells pass through the BBB from the systemic circulation to CNS
Immune cells may re-activate and produce cytokines
Immune cells mount autoimmune attack against myelin in the CNS –> demyelination

26
Q

Patients typically present with focal/global neurological deficits

A

Focal

27
Q

Clinical features - If there are lesions in the pyramidal tracts

A

Increased tone
Spasticity
Weakness
Upper limbs get spasticity in flexion - weakness extending elbow and flexing wrist
Lower limbs get spasticity in extension - weak flexing hip, knee and dorsiflexing ankle

28
Q

Clinical features - if there are lesions in optic nerves

A

Unilateral painful visual loss
Colour vision is lost first
RAPD

29
Q

Clinical features - sensory symptoms

A

Either loss of sensation or too much sensation

30
Q

Clinical features - lower urinary tract dysfunction

A 
Frequency 
Nocturia
Urgency 
Urge incontinence 
Retention
31
Q

Clinical features - if there are lesions in the cerebellum

A 
Ataxia 
Intention tremor 
Nystagmus 
Pendular reflexes 
Dysdiadokinesis (coordination problems) 
Dysarthria
32
Q

Clinical features - internuclear ophthalmoplegia

A

Fast movement of eyeballs is impaired

diplopia when trying to adduct

33
Q

Diagnostic testing is required. True or false ?

A

False

- clinical diagnosis

34
Q

Investigations

A

MRI scan

Lumbar puncture

35
Q

Investigations - MRI scan

A

Presence of demyelinating plaques

Dawsons fingers

36
Q

Investigations - lumbar puncture

A

Presence of IgG oligoclonal bands in CSF

37
Q

IgG oligoclonal bands found in CSF are distinct to MS. True or false?

A

False

- can be found in other conditions

38
Q

Which criteria need to be met for a diagnosis of MS to be made?

A

McDonald criteria

39
Q

Mcdonald criteria

A

At least 2 episodes suggestive of demyelination occurring at different times and places

A neurological deficit implicating one neuro-anatomical site, and a MRI appreciated defect at another neuro-anatomical site

Multiple distinct CNS lesions on MRI

40
Q

Management - acute moderate exacerbation

A

Oral steroids

41
Q

Management - acute severe exacerbation

A

Hospital admission

IV steroids

42
Q

Management - pyramidal dysfunction

A

Physiotherapy
Occupational therapy
Anti-spasmodic treatment

43
Q

Management - spasticity

A

Physiotherapy
Oral: Baclofen / tizanidine
Botox
Intratheal : Baclofen / phenol

44
Q

Management - sensory symptoms

A

Anti-convulsant
Anti-depressant (amitryptiline)
Tens machine
Acupuncture

45
Q

Management - fatigue

A

Amantadine

Modafnil

46
Q

Disease modifying therapy = First line therapy

A

Interferon beta

  • avonex
  • rebif

Glitiramer Acetate (copaxone)

Tecfedira

47
Q

Disease modifying therapy has an increased risk of malignancy. True or false?

A

True

48
Q

Disease modifying therapy - second line therapy

A

Monoclonal antibody

49
Q

When do you accelerate from first line to second line therapy?

A

If first line therapy isn’t making any change to the MRI scan appearance

50
Q

Which MAb therapy must be given on the ward as it causes cardiac problems?

A

Fingolimond

51
Q

Which MAb is for patients with highly active relapsing remitting MS ?

A

Lemtrada

Tysabri

52
Q

Disease modifying therapy - third line therapy

A

Stem cell transplantation

53
Q 
Which of the following are treatment options for the sensory symptoms in ms? (More than one correct answer)
TENS machine
Oxybutinin
Gabapentin 
Baclofen
Amitryptiline
A

TENS machine
Gabapentin
Amitryptiline

54
Q

Which steroid is used in the treatment of mod-severe Acute attacks of MS?
A prednisolone
B dexamethasone

A

A

55
Q

What investigation has a vital role in assessing response to disease modifying therapy in ms?

A

MRI

Neurology SOH (31 decks)

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