Neurology - Multiple Sclerosis Flashcards
Define multiple sclerosis?
A chronic auto-immune inflammatory condition of the CNS characterised by multiple plaques of de-myelination disseminated in TIME and SPACE
Describe the basic pathophysiology behind MS?
Type 4 hypersensitivity reaction - T-cell mediated destruction of the myelin and the oligodendrocytes leaving behind scarred ‘plaques’ on the axxons.
Name four risk factors associated with MS?
Female
FHx - HLA DR2
Vit D deficient
Previous EBV (glandular fever)
Name the four different patterns of the disease?
- Relapsing-remitting (80%)
- Secondary progressive
- Primary progressive (10%)
- Progressive relapsing
Describe RRMS?
Relapses occur typically every 1-2 years. Affects one area and then the patient recovers however re-myelination is not complete and this leaves behind irreverable damage along following each bout. Baseline disability accumulates follwoing each bout.
Describe secondary progressive MS?
Similar to RRMS however over time the remissions cease and a constant progressive deterioration of syx and O/E follows.
Describe primary progressive MS?
Progressive decline from the onset. Constant attack on myelin by immune cells. Often lower limb and ambulatory syx and O/E. Affects older people typically.
Descibe the overall basic principal of the syx with MS?
- Varied and depends on plaque location
- Syx last over 24 hours and recovery can be between days/weeks/months
- Absence of other causes
- Does NOT affect the peripheral nervous system
What is charcot’s neurological triad?
- Dysarthria
- Nystagmus
- Intension tremor
Describe optic neuritis?
Plaques around the optic nerve and nerve to MOEM
Onset over hours - recovery over weeks
Pain on eye movement and double vision and loss of vision and flashing lights
Classically fundoscopy = normal
Describe transverse myelitis?
Inflammation of the spinal cord - commonly T
Ascending numbmess with sesory level affected with a tight band across the abdomen and UMN in lower limb (increased tone = spastic gait)
Constiapation and urinary incontinence
Describe brainstem syndromes found with MS?
CN 2 - double vision CN 7 - trigeminal neuralgia and facial numbmess/palsy CN 8 - Vertigo and deafness CN 9 - swallow difficulties Intranuclear opthalmoplegia Cerebellar signs - DANISH
Which side is the lesion in a unilateral case of INO?
IPSILATERAL to the eye that does not ADduct (move towards the midline/medial) as for example the R medial rectus is not working (no ADduction) meaning the problem is with the R medial longitudinal fasiculus.
What is Lhermitte’s sign and Uthof’s sign?
Lhermittes - electrical shock down trunk and limbs when bending neck forwards
Uthof’s - remyelinated nerve is thinner and so with heat/exercise = decreased vision.
What investigations should be carried out in MS and which diagnostic criteria?
CSF - oligoclonal bands
MRI - white matter plaques
Evoked potentials
Macdonald’s diagnostic criteria
Describe the medical Mx of RRMS?
Acute flare ups - methylprednisalone 1g iv
Preventing relapses -
1. Biologics - Alemtuumab and Natalizumab (monoclonal Abs)
2. DMARDS - IFN-Gamma (decreases relapses by 30%)
Syx control!!
