[Neuro] Multiple Sclerosis Flashcards
what is multiple sclerosis (MS)?
most common immune-mediated demyelinating disease of the CNS
how many types of MS are there and what is the most common?
4 types; relapsing-remitting
what is the 1st line ix for MS?
MRI head / spine
how can a dx of MS be made?
neurological features and MRI findings disseminated in time and space
what are the radiological features in MS: white matter lesions?
in:
- periventricular (Dawson’s fingers)
- corpus callosum
- infratentorial region
what are the radiological features in MS: T2 weighted MRI?
hyperdense lesions
what are the radiological features in MS: T1 weighted MRI?
hypodense lesions
what is the main differential for MS?
neuromyelitis optica
what are the features of neuromyelitis optica?
- more severe inflammation, disability and mortality associated with relapses
- white matter of optic nerve / spinal cord involved
- anti-aquaporin channel 4 antibody +ve
what are the motor signs of MS?
- spasticity
- cerebellar ataxia
- UMN signs only
what are the visual signs of MS?
- optic neuritis
- bilateral internuclear ophthalmoplegia
- oscillopia
- RAPD
what are the specific signs in MS?
- Lhermitte’s syndrome
- Uhthoff’s phenomenon
what are other signs of MS?
- neuropathic pain
- cognitive decline
- emotional lability
- urinary urgency / incontinence
pt with MS has spasticity sx. what is the 1st line rx?
baclofen or gabapentin
what is spasticity in MS exacerbated by?
- constipation
- UTI / other infections
- pressure ulcers
- posture
pt with MS has spasticity sx but sx not resolved with 1st line rx. what next?
trial of the other 1st line agent or
2nd line: dantrolene or tizanidine
pt with MS has spasticity sx but sx not resolved with 1st and 2nd line rx. what next?
3rd line: benzodiazepines
when is methylprednisolone used in MS?
3-7 days for acute exacerbation of MS (new sx / worsening of existing sx for ≥24 hours, in absence of infection
what are the disease modifying agents used in MS, specifically RRMS?
- interferon beta
- glatiramer
- natalizumab / ocrelizumab
what does interferon beta do?
reduces number of relapses
but does not reduce overall disability
what does glatiramer do?
reduces number of relapses
antigenically similar to myelin basic protein
s/c injection
what does natalizumab / ocrelizumab do?
highly effective for RRMS
recombinant monoclonal antibody
but risk of PML (JC virus)
oligoclonal bands, high protein. dx?
MS LP findings
campylobacter, ascending polyneuropathy, anti-GM-1. dx?
Guillan-Barre syndrome
