Weakness Flashcards
Describe the pathophysiology of multiple sclerosis
- Autoimmune demyelination
- Affects CNS only
Which group of people are most commonly affected by multiple sclerosis?
Young women
Describe the clinical features of multiple sclerosis (presentation, pattern, characteristic features)
Two or more episodes of CNS dysfunction disseminated in space (clinically or on MRI) and time (>1 month apart)
Relapsing-remitting pattern
Characteristic features:
- Optic neuritis (blurred vision, unilateral eye pain)
- Brainstem lesions (diplopia, dysphagia, dysarthria, facial weakness/paraesthesia)
- Spinal cord lesions (limb weakness/paraesthesia, sexual dysfunction, bladder/bowel dysfunction)
What is Uhthoff’s sign?
Temporary worsening of MS signs caused by an increase in temperature (e.g. hot bath)
what is Lhermitte’s sign?
MS sign - sudden, ‘electric-shock’ sensation, typically from the neck down into the spine
Describe the investigation of multiple sclerosis
MRI
LP shows oligoclonal bands
Describe the management of multiple sclerosis
- Steroids
- Beta-interferon
What are the clinical features of spinal cord compression?
Weakness and paraesthesia of the legs (and arms, if the level of compression is above the thoracic spine)
- Bladder/bowel involvement
What are the causes of spinal cord compression? How can the causes be classified into two categories?
Acute:
- Trauma
- Infection
Chronic:
- Tumour (i.e. metastasis)
- Osteoarthritis
Describe the investigation of spinal cord compression
MRI
Describe the management of spinal cord compression
Surgical decompression
Describe the pathophysiology of cauda equina syndrome
Spinal damage at or below L1, resulting in compression of the cauda equina
What is the most common cause of cauda equina?
Give some other causes
- Lumbar disc prolapse (most common)
- Tumour
- Trauma
- Infection
What are the clinical features of cauda equina?
- Leg weakness and paraesthesia
- Low back pain
- Bladder/bowel dysfunction
- Saddle anaesthesia
Describe the investigation of cauda equina
MRI
Describe the management of cauda equina
Surgical decompression
Describe the pathophysiology and aetiology of Guillian-Barre syndrome
This is usually triggered by…
- Autoimmune demyelination
- Polyneuropathy (affects multiple peripheral nerves)
Usually triggered by an infection, e.g. Campylobacter
Describe the clinical features of Guillian-Barre syndrome
Give an example of a life-threatening complication of Guillian-Barre syndrome
- Ascending limb weakness and paraesthesia
- Autonomic dysfunction, e.g. postural hypotension, cardiac arrhythmia
Potential complication: life-threatening respiratory muscle weakness
Describe the investigation and diagnosis of Guillian-Barre syndrome
Diagnosis:
- Clinical diagnosis
Investigation:
- LP: isolated rise in protein
- Nerve conduction studies (NCS) show demyelination
Describe the management of Guillian-Barre syndrome
IVIG (alternatively plasma exchange)
Describe the prognosis of Guillian-Barre
Extremely variable - recovery may take weeks to years
Describe the pathophysiology of radiculopathy
Spinal nerve root impingement
What are the causes of radiculopathy
- Disc prolapse
- Tumour
- Trauma
- Osteoarthritis
What are the clinical features of radiculopathy? (cervical and lumbar)
Cervical radiculopathy:
- Weakness, paraesthesia in the upper limbs
Lumbar radiculopathy:
- Weakness, paraesthesia in the lower limbs, bladder/bowel dysfunction, sexual dysfunction
