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Flashcards in MS Deck (35)
1

What is the specific characteristic of the lesions that makes the diagnosis of MS?

The lesions must be disseminated in space and time

2

Despite no known cause what are the risk factors for MS?

Affected family members and lack of sunlight exposure/vit D

3

Raised risk due to lack of sunlight means that which areas are more affected?

Temperate counties while those by the equator have lower prevalence of MS

4

What age and sex is it most common in?

Women (3:1)
30 years old

5

Prevalence in normal population? (Per 100000)

42

6

What are the chances of getting MS if you have an affected twin?

1/4

7

What are the chances of developing MS if you have an affected sibling who isn't a twin?

1/30

8

Give the categories of symptoms that the patient may present with (E.g. Visual)...

Visual, eye movement, facial weakness, hearing and balance, cognitive, taste, psychological, sexual, unpleasant sensations, numbness, myelitis, autonomic and other

9

What visual problems may occur?

Hemianopia, blindness

Often only affects one eye

10

What eye movement problems may occur?

Nystagmus, double vision (diplopia cn 3,4,6 lesions)

11

What facial movement issue might occur?

Bell's palsy

12

What hearing and balance symptoms may occur?

Deafness, unsteadiness, vertigo, vomiting, nausea

13

What cognitive issues may occur?

Reduced visual and auditory attention, reduction of intellect

14

Are psychological issues common?

No but depression often develops as the disease progresses

15

What unpleasant sensations may occur?

Tightness, burning, tearing (due to damage to posterior column) Lhermittes sign (neck flexion causes electric shock sensation), loss of thermal sensation, tingling

16

What occurs in transverse myelitis?

Episode of paralysis of both legs and sensation, loss of bowel and bladder control

17

What autonomic issues may occur (includes sexual)...

Loss of thermoregulation (pyrexia, XS sweating), loss of bladder control, increased urinary frequency/urgency, erectile dysfunction

18

Name 2 other features that may occur?

Horners syndrome
Weight loss
Arrythmias

19

What criteria are used for diagnosing MS?

McDonald criteria

20

What clinical evidence is enough to provide a diagnosis of MS?

2 or more attacks with 2 objective clinical lesions

21

What is the problem with MRI?

It is highly sensitive but it is not specific

22

What percentage of those who have an MS episode with a consistent MRI develop MS?

90%

23

What are the three forms of MS?

Relapsing remitting, primary progressive, secondary progressive

24

What is the ratio of relapsing-remitting to primary progressive?

85:15

25

What percentage of those with relapsing remitting develop secondary progressive?

75%

26

What other investigations can you do to back up your clinical diagnosis?

MRI, CSF, evoked potentials for auditory, visual and somatosensory senses (looking for delay)

27

What might CSF electrophoresis testing show? What does this suggest?

Oligoclonal IgG bands which aren't present in serum.

Suggests CNS inflammation

28

What is the conservative management for MS?

Encourage reduction in stress, minimise disability, if there is poor diet or reduced sun exposure give vitamin D

29

What is the management for relapse?

Give methylprendisalone IV for 3 days to shorten relapse

30

What is the pharma management for reducing relapses?

Interferons or azathioprine , alemtuzumab/natalizumab, dimethyl fumurate (if two relapses in past year)

31

How much does interferon beta/ azathioprine reduce relapse rate?

30%

32

What percentage does natalizumab reduce relapse rate by? And no. Of MRI lesions?

68%
92%

33

What drugs are given for treating primary progressive MS?

There are no drugs that have shown significant effect in treating primary progressive

34

When patients become progressive what is the focus of treatment?

Symptom relief for palliation

35

What is MS?

T cells mediated demyelination of multiple CNS sites, which heals very poorly leading to relapsing and remitting symptoms. If demyelination occurs long enough there may be axonal loss and progressive symptoms.