Neuro - MS Flashcards
What does MS involve
inflammatory process involving demyelination of neurones in the CNS
What cells produce myelin?
CNS - oligodendrocytes
PNS - schwann cells
how to describe MS lesions?
disseminated in space and time
causes
multiple genes low vitamin D smoking obesity EBV
timing
progress over more than 24 hours
first presentation - last days-weeks then improve
most common presentation
optic neuritis
optic neuritis
demyelination of optic nerve and loss of vision in 1 eye
why may patients present with double vision?
6th cranial nerve lesions
6th cranial nerve palsy - 2 key phrases
internuclear ophthalmoplegia
conjugate lateral gaze disorder
lateral gaze disorder example
lesion affecting left eye
look to left - right eye adduct
left eye remain in centre
Lhermitte’s sign
electric shock sensation down spine and into limbs when flexing the nerve
what does Lhermitte’s sign indicate?
disease in cervical spinal cord in dorsal column
2 types of ataxia
sensory and cerebellar
sensory ataxia
loss of proprioceptive sense
joint position
positive rombergs test
cerebellar ataxia
problems cerebellum coordinating movement
suggests cerebellar lesions
types of MS
relapsing remitting
primary progressive
secondary progressive
can MS be diagnosed on one episode?
no - not disseminated in space and time
most common type at diagnosis
relapsing-remitting
investigations
MRI scan
Lumbar puncture
electrophysiology - visually evoked potentials
LP findings
oligoclonal bands - CSF
4 main features of optic neuritis
central scotoma
pain on movement
impaired colour vision
afferent pupil defect
other causes of optic neuritis
sarcoidosis SLE DM lyme disease mumps and measles
treating relapses
methylprednisolone 500mg for 5 days
symptomatic treatment
exercise amitriptyline and gabapentin SSRIs baclofen/physio anticholinergic medications
what scoring system is used to predict likelihood of MS?
Mcdonalds criteria
Preventing exacerbations
IFN-beta
IV emthotrexate
natalizumab
