Multiple Sclerosis Flashcards

1
Q

What is MS? What types are there?

A

Chronic autoimmune disorder
Plaques of demyelination are found throughout the brain and spinal cord, relapsing/remitting - dissemination of symptoms in space and time crucial for diagnosis
Goes from relapse/remitting to secondary progressive phase. Also can get primary progressive MS (10-15%), presents in 5th/6th decade).

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2
Q

What are the types of symptoms/signs of MS?

A

Most cases present with a relapse - gradual onset over days

Relapse symptoms

  • Optic neuritis
  • Myelitis/Spinal cord symptoms
  • Brainstem symptoms

Progressive symptoms

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3
Q

What are the symptoms of optic neuritis in MS?

A
Subacute visual loss
Pain on moving
Colour vision disturbed
Optic disc swelling sometimes
Optic atrophy seen later
Relative afferent pupillary defect
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4
Q

What are the brainstem related symptoms/signs of MS?

A
Diplopia
Vertigo
Facial numbness/weakness
Dysarthria
Dysphagia
Nystagmus
Bilateral internuclear opthalmoplegia = pathognomonic for MS
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5
Q

What are the myelitis related symptoms/signs of MS?

A
Paraparesis developing over days or weeks
Numbness/tingling
Often with band of hyperaesthesis
Weakness below level
Bladder/bowel involvement
May be painful
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6
Q

What are the symptoms of the progressive stage of MS?

A
Fatigue
Temperature sensitivity
Sensory symptoms
Stiffness/spasms
Balance, speech issues
Poor balance, speech problems
Swallowing issues
Bladder/bowel problems
Cognitive/emotional problems
Brainstem symptoms
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7
Q

What investigations might be done in suspected MS?

A

Examination

  • cranial nerves
  • cerebellar, sensory signs
  • UMN signs
  • plantaris extensor

MRI
- 1 relapse per 10 lesions

Others

  • LP - oligoclonal bands in CSF but not serum
  • Bloods to exclude other conditions
  • CXR
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8
Q

Possible differential diagnoses of MS?

A

Inflammatory disorders - Devics, SLE, Sarcoidosis
Infection - HIV, HSV, TB, Borrelia
Tumour
Stroke

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9
Q

General treatments for MS?

A

Acute relapse

  • look for underlying infection
  • oral/IV prednisolone
  • rehab
  • symptomatic treatments

Longer-term

  • disease modifying treatments
  • vaccinations
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10
Q

What are the disease-modifying treatments in MS?

A

Beta-inferferons
Glatiramer acetate

Teriflunomide
Dimethyl fumarate

Others

  • Natalizumab
  • Fingolimod tablets
  • Alentuzumab
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11
Q

Symptomatic treatments in MS?

A
Spasticity - muscle relaxants/antispasmodics
Dyaesthesia - Amitripyline, Gabapentin
Urinary - anticholinergic, bladder stimulator/catheter
Constipation - laxatives
Sexual dysfunction - sildenafil
Fatigue - exercise, medication
Depression - CBT, medication
Cognitive - memory aids
Tremor - aids, pharmaceuticals
Vision/oscillopsia - Carbamazepine
Speech/swallowing - SALT
Motor/sensory - MDT
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12
Q

Risks in treating MS with immunosuppressants?

A

Progressive Multifocal Leukencephalopathy

caused by JC virus

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13
Q

What causes the demyelination in MS?

A

Activated T cells cross BBB causing demyelination
Acute inflammation of sheath leading to loss of function
Repair = recovery
Post-inflammatory gliosis

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14
Q

What causes MS? (Pathogenesis?)

A
Complex genetic inheritance
Females 2-3x more likely
Commoner in temperature climate
Vitamin D link?
EBV?
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