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Neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Features of MS

A

Auto-immune inflammatory disease
Affects the CNS
Relapsing and remitting –> progressive
Demyelination and axonal degeneration

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2
Q

Features of transverse myelitis

A

Inflammatory demyelination of the spinal cord
Subacute non-compressive myelopathy
Symptoms over hours to days –> improvement over weeks to months

Causes:

  • Infection - CMV, EBV, Mycoplasma, HTLV, HIV
  • MS
  • Idiopathic
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3
Q

Features of optic neuritis

A

Presenting symptom of MS in 20-50%

Acute or subacute unilateral eye pain
Variable degree of visual loss
Colour desaturation
RAPD or marcus gunn pupil

Improves over weeks -months

Risk of progression to MS by MRI - T2 lesions

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4
Q

Diagnosis of optic neuritis?

A

Visual provoked responses

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5
Q

CSF for the diagnosis of MS?

A

Evidence of Intra thecal immunoglobulin synthesis
Only in CSF not serum

Adds prognostic value for the development of MS after a single attack

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6
Q

What is L’Hermitte’s sign?

A

Shock like sensation when neck is flexed

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7
Q

What is Uhtoff’s phenomenon?

A

Reversible and stereotypic decrements in physical and cognitive function due to increased body temperature

Nerve conduction slowing due to increased core temp

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8
Q

After a single demylinating event who gets MS?

A

Predicted by number of T2 lesions on MRI

Presence of oligoclonal bands on CSF increases risk

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9
Q

Why treat MS early?

A

Physical and cognitive outcomes are determined early in the disease = Benign MS is not benign

Early treatment reduces lesions and disease burden

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10
Q

Diagnosing MS on MRI?

A

Dissemination of lesions in time and space

Dissemination in space:
Lesions in 2 or more areas of CNS - periventricular, juxtacortical, infratentorial, spinal cord

Dissemination in time:
New lesion on follow up imaging OR simultaneous non-enhancing and enhancing lesions

Cerebral atrophy
T1 hypointense - black lesions of permanent axonal loss

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11
Q

What is devic’s disease?

A

Relapsong-remitting involvement of the optic nerves and spinal cord

MRI = long lesions without brain involvement
Anti-aquaporin 4 antibodies
Anti-MOG antibodies

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12
Q

What is acute disseminated encephalomyelitis?

A

Infectious prodrome 1-4weeks prior

–> encephalopathy with behavioural changes

Most recover

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13
Q

PML V.s. MS

A

Reactivation of the JC virus
–> progressive demyelinating and fatal infection of the brain

Subacute onset
Progressive over weeks
Behavioural and neuropsychological alteration

MRI = Large >3 lesions, subcortical T2 lesions
JCV PCR of CSF is diagnostic

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14
Q

Treatment of PML

A

Stop immunosuppression

Consder immune reconstitution but risk of IRIS

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15
Q

Aetiology of MS

A

Genetics:

  • Family history
  • HLA-DR2

F>M
Latitude gradient -? role of vitamin D
Smoking
EBV

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16
Q

Pathology of MS

A

Bias towards Th1 and Th17 response and T cell regulatory dysfunction
–> disruption of the BBB –> T cell entry into the CNS –> damage to myelin, oligodendrocytes and axons due to cytokines, antibody activity, complement, oxidative stress and mitochondrial dysfunction

17
Q

Poor prognostic factors?

A 
Male
Older age of onset
High attack rate in first 5 yrs
short inter-relapse intervals
cognitive impairment
Cerebral atrophy
18
Q

Biological effects of Methylprednisone in MS

A

Restores BBB
Reduces oedema
Suppresses inflammation

19
Q

Interferon side effects

A

Injections
Must build up does slowely

Flu like symptoms at commencement
Injection site reactions
LFT abnormalities 
Risk of worsening depression
Can form anti-interferon Abs --> ineffective treatment
20
Q

Glatiramer acetate

A

Polypeptide containing myelin basic protein
? changes Th2 cytokines and macrophage function

Daily injection

Injection site reactions
Safe in pregnancy

21
Q

Natalizumab

A

Monoclonal antibody to alpha-4 integrin
–> inhibits migration of lymphocytes and monocytes into the CNS

IV monthly infusion

Risk of PML - long exposures, JCV serology and previous exposure to an immunosuppressant
Infusion reactions
LFT abnormalities

22
Q

Fingolimod

A

S1P receptor modulator
–> retains lymphocytes in lymphoid organs

Oral tablet

Lymphopenia
Hypertension
PML

23
Q

Dimethyl fumarate

A

Modulates Nrf2
Anti-inflammaotry and cytoprotective

Diarrhoea, nausea, vomiting
Abdominal pain
PML

24
Q

Teriflunomide

A

Active metabolite of leflunomide
Interferes with lymphocyte proliferation

Alopecia

25
Q

Alemtuzumab

A

Anti-CD52 antibody

Infusion

ITP
Graves disease
Goodpastures syndrome

Neurology (6 decks)

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