Neurology 4 - Multiple Sclerosis Flashcards
define multiple sclerosis
immune attack against the myelin sheath, leading to demyelination of oligodendrocytes in the central nervous system
tends to relapsing-remitting
lesions disseminated in time and space
Schwann cells where
peripheral nervous system myelinating cells
early MS
re-myelination can occur with symptom resolution
possible contributing factors to MS developing
smoking EBV low vitamin D obesity genetic
eye symptoms in MS
optic neuritis - most common presentation, demyelination of optic nerve and loss of vision in one eye
internuclear ophthalamoplegia - conjugate lateral gaze disorder
(normally sixth nerve palsy)
common focal weakness / sensory dysfunction in MS
Bell’s palsy
Horner’s syndrome
limb paralysis
incontinence
trigeminal neuralgia
numbness
pins and needles
Lhermitte’s sign
what is Lhermitte’s sign
electric shock sensation on neck flexion due to lesion on dorsal columns
sensory ataxia in MS
can lose proprioceptive sense and have pseudoathetosis writhing movements
can also get cerebellar ataxia too
4 disease patterns in MS
clinically isolated syndrome (first episode)
relapsing-remitting - most common (described as non/active and not/worsening)
secondary progressive - no longer getting complete remissions (described as non/active and not/progressing)
primary progressive - progressive worsening right from first symptoms for at least a year
lumbar puncture MS
may see oligoclonal bands
which scan is used for MS
MRI
4 key features of optic neuritis
central scotoma (enlarged blind spot)
pain on moving eyes
impaired colour vision
relative afferent pupillary defect RAPD
DDx optic neuritis x7
multiple sclerosis (1/2 develop MS in next 15 yrs!)
sarcoid SLE diabetes syphilis measles mumps lyme disease
management of MS
MDT, incl MS nurse
disease-modifying drugs + biologics
managing complications (manage neuro pain, depression, incontinence, spasticity)
treating MS relapses
500mg methylpred OD 5 days
if severe relapse can infuse 1g daily for 3 days
