Multiple sclerosis (N) Flashcards
Define MS.
Chronic, inflammatory demyelinating disease of the CNS characterised by the presence of episodic neurological dysfunction in at least two areas of the CNS (brain, SC and optic nerves) separated in time and space
What does MS result in?
Discrete plaques of demyelination and axonal degeneration in the brain and spinal cord
What response is involved in MS?
T-cell mediated immune response
What is a specific condition the features have to fulfil to be classed as MS?
Separation in time and space - lesions in the CNS must have occurred in at least 2 different places and at least 2 different times
Two episodes of neurological dysfunction that are separated in time and space
What are the different forms of MS? (5)
- relapsing-remitting MS
- primary progressive MS
- secondary progressive MS
- clinically isolated syndrome
- Marburg variant
What is relapsing-remitting MS like?
- most common (85%)
- acute attacks (last 1-2 months) with complete recovery in between attacks
What is primary progressive MS like?
- 10% of patients
- progressive deterioration from onset - no relapsing/remitting, straight progressive, steady accumulation of disability
What is secondary progressive MS like?
- progressive accumulation of disability AFTER initial relapsing-remitting course
- relapsing-remitting patients who have deteriorated and developed neurological signs between relapses
- 65% progress from relapsing-remitting –> secondary progression
What is clinically isolated syndrome (MS) like?
- single clinical attack of demyelination
- attack itself does not count as MS
- 10-50% progress to MS
What is Marburg variant (MS) like?
Severe fulminant variation of MS –> advanced disability or death within weeks
Which demographics is MS most common in? (3)
Most common is young, white female
- female
- 20-40 years old
- white
What are the causes of MS? (2)
- genetic predisposition
- environmental factors e.g. low vitamin D, smoking, EBV
What is the earliest manifestation of MS? (1+6)
Optic neuritis (inflammation of the optic nerve) - earliest and most common presentation
- unilateral, impaired vision
- colour blindness
- rapid loss of central vision
- pain on eye movement
- RAPD - both pupils appear dilated when eye illuminated in swinging torch test
- central scotoma
What is another visual phenomenon that may be seen in MS?
Intranuclear ophthalmoplegia - lesion of the medial longitudinal fasciculus, blocking connection between contralateral CN6 nucleus and ipsilateral CN3 nucleus, affecting horizontal gaze
–> nystagmus of the abducting eye with absent adduction of the other (ipsilateral) eye
(or isolated nystagmus)
What would a right intranuclear ophthalmoplegia look like (MS)?
Right eye unable to adduct, and nystagmus will occur in left eye simultaneously i.e. when it is abducting
What types of symptoms might we see in MS? (6)
- visual
- sensory
- motor
- cerebellar
- autonomic
- others - psychological/cognitive
What are some visual symptoms of MS? (5)
- optic neuritis (initial and most common) - vision loss, pain
- intranuclear ophthalmoplegia (contralateral medial longitudinal fasciculus lesion) = lateral horizontal gaze
- spastic paraparesis - papillitis, transverse myelitis
- acute paraparesis - visual loss, neuromyelitis optica
- Uhtoff’s phemomenon - worsening of vision following rise in body temperature
What are some sensory symptoms of MS? (5)
- paraesthesia, pins and needles, numbness
- burning
- odd sensation of patch of wetness/burning
- hemibody sensory loss or tingling
- Lhermitte’s sign - paraesthesia in limbs on neck flexion
What are some motor symptoms of MS?
- limb weakness - after walking, leg cramping
- spasms
- stiffness
- heaviness
