Patient talk Flashcards
what treatment helps binocular double vision
a patch on one eye
what could give you monocular double vision
retinal detachment
is monocular or binocular double vision more neurological
binocular
which localisation does loss of balance suggest
cerebellum
imaging choice to diagnose MS
MRI
what localisation does numbness from the weight down suggest
thoracic spinal chord
it is tightly packed so a small lesion can cause bilateral dysfunction
what localisation does numbness in 1 leg suggest
lesion in sensory cortex of the brain
which test, other than MRI, can confirm MS
lumber puncture
immunoglobulin test positive
what can bad lumbar puncture technique cause
headache
reduced mobility
nausea
now smaller needles much less likely for CSF leaks through puncture
2 stages of MS
relapsing remitting MS
secondary progressive MS - symptoms get worse over time
treatments available
many for RR MS
none for secondary progressive MS
MS definition
a chronic inflammatory disease of CNS of unknown cause causing oligodendroglial and axonal pathology
who is affected by MS
typically young adults with relapsing-remitting pattern or chronic progressive evolution
how do you diagnose MS
cerebrospinal fluid (CSF)analysis typically shows indicies of inflammation MRI demonstrates characteristic legions in CNS matter - high signals = white spots
onset and symptoms of MS
present in young adults - 20-40yrs
involve any neurological function - most commonly sensory, motor and visual symptoms
clinical course of MS
begin as relapsing-remitting disorder
evolve into progressive course (secondary progressive MS)
diagnosis of MS - summary
based on clinical history
supported by CSF analysis and MRI
pathophysiology of MS
cause unknown
inflammation
loss of myelin in CNS
therapy
immuno-modulatory and immuno-suppressive treatment (introduced n 1990s) reduce relapses
effect on evolution and progressive MS still unclear
case summary - relapse-remitting
age 17 - nauseam double vision, L sided numbness - presenting relapse
Attend AandE - lumber puncture, brain infection/inflammation suspected - complete recovery 3 wks
1997 - recurrence - 2nd relapse
1998 - leg numbness waist down, imbalance - 3rd relapse
same winter - 4th relapse
1979 - L leg numbness 10 days - recovery - 5th relapse
1985 (aged 36) - sensory disturbance in mouth - 6th relapse
seen at SMH. LP - confirm inflammation in CNS - diagnosis of relapsing-remitting MS - no treatment
case summary - secondary progressive MS
1993 (34) - limping L leg 1995 - stick '97 - 1 then 2 crutches 2000 onwards - wheelchair occasionally 2003 - wheelchair bound progressive deterioration over 15 years tetraplegic
