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Flashcards in Conditions Deck (18)
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1
Q

Describe the formation and appearance of plaques in MS (active vs. inactive).

A

T cell acute inflammation attacking myelin and oligodendrocytes. Plaques form around damaged axons due to incomplete healing. Progressive inflammation occurs since BBB disrupted.
Active plaques = perivascular inflammatory cells, microglia, ongoing demyelination. Yellow/brown, ill-defined edge (blends into white matter).

Inactive plaques = gliosis, few myelinated axons remain, less oligodendrocytes (“burnt out” active plaque). well-demarcated, grey/brown lesions, classically situated around lateral ventricles.

2
Q

Signs of optic nerve involvement in MS?

A
optic neuritis - unilateral, painful eye movement or visual loss.
Colour desaturation (red)
RAPD on swinging light test
pale optic disc
reduced visual acuity
3
Q

Pyramidal dysfunction signs in MS?

A

UMN features - spasticity, weakness, hyper-reflexia etc.
Extensors of upper limb and flexors of lower limb.
Tonic spasms of lower limbs.
Pronator drift.

4
Q

Sensory signs in MS?

A

“water trickling down skin” but dry = pathognomic
loss of DCML, e.g. PC is clumsiness since loss of fine touch, proprioception
numbness, tingling

5
Q

Brainstem signs in MS?

A

CN signs
ataxia
nystagmus
internuclear ophthalmoplegia (INO)

6
Q

What is internuclear ophthalmoplegia (INO)?

A

horizontal diplopia - brainstem demyelination affecting the medial longitudinal fascicles (MLF) on one or both sides.
E.g.
A right INO will result in an inability to Adduct the right eye and a nystagmus of the left eye on attempted horizontal gaze.
Bilateral INO is pathognomonic of MS.

7
Q

Risk factors for MS.

A

high altitude living
previous EBV infection
1st degree relative with MS
HLA DRB1

8
Q

Common places to find plaques in MS?

A

adjacent to lateral ventricles, corpus collosum, optic nerves & chiasm.

9
Q

Diagnosis of MS.

A

2 distinct neurological defects occurring at different times.
Multiple distinct CNS lesions on T2 weighted MRI (hyper intense white matter lesions)

10
Q

Supportive features for MS diagnosis?

A

CSF analysis shows JgG oligocloncal bands

Visual evoked potentials (evidence of slowed conduction)

11
Q

How do you help a patient with MS cope with symptomatic spasticity?

A

physio, OT + oral anti-spasmodic (e.g. baclofen or tizanidine)

botox; intrathecal baclofen if bed bound

12
Q

What options are there to help a patient cope with sensory symptoms?

A

TENS machine, acupuncture
gabapentin for neuropathic pain
antidepressant e.g. amitriptylline
lignocaine infusion to reset pain threshold

13
Q

What options are there to help a patient with MS cope with fatigue?

A

OT
amantidine ± modafinil if excessive daytime somnolence

hyperbaric oxygen - pressure chamber - can help fatigue and bladder symptoms

14
Q

How would you treat a moderate relapse of MS?

A

PO methylprednisolone 500mg daily for 5 days

15
Q

How would you treat a severe relapse of MS?

A

hospitalisation and IV steroids

16
Q

What is 1st line disease modifying therapy for MS?

A

Tecifidera (R-R); interferon beta, glatiramer acetate (pregnant)

17
Q

When would you move to 2nd line disease modifying therapy and what options are there?

A

if patient is already on interferon but new plaques seen on MRI
Tysabri, fingolimod, cladrabine

18
Q

Which disease modifying drug is 1st line in early primary progressive MS only?

A

ocrelizumab