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Flashcards in MS Deck (32):
1

What is MS?

Inflammatory demyelinating disorder of the CNS
Plaques disseminated in time and place

2

Are women or men more commonly affected by MS?

Female: male = 3:1

3

What are the different clinical courses of MS?

Relapsing remitting; 90%
Secondary progressive
Progressive relapsing
Primary progressive

4

What are the clinical features of MS?

Pyramidal dysfunction
Optic neuritis
Sensory symptoms
Lr urinary tract dysfunction
Cerebellar and brain stem features
Cognitive impairment

5

What are the symptoms of pyramidal dysfunction in MS?

Increased tone
Spasticity
Weakness
Extensors of upper limbs
Flexors of lower limbs
UMN LESION

6

What are the symptoms of optic neuritis?

Painful visual loss on eye movement
RAPD
Central scotoma

7

How long will optic neuritis last in MS?

1-2 weeks

8

What sensory symptoms are associated with MS?

Pain
Paraesthesia
Dorsal column loss; proprioception and vibration
Numbness
Trigeminal neuralgia

9

What cerebellar symptoms are associated with MS?

Dysarthria
Ataxia
Nystagmus
Intention tremor
Past pointing
Pendular reflexes
Dysdiadokinesis

10

Will cerebellar problems be contra or ipsilateral?

Ipsilateral

11

What brain stem dysfunctions are commonly seen in MS?

Diplopia; CN6 palsy
Facial weakness; CN 7 palsy

12

What causes internuclear ophthalmoplegia?

Medial longitudinal fasiculus

13

What will be seen in INO?

Distortion of binocular vision
Failure of adduction; diplopia
Nystagmus in abducting eye
Lag

14

What lr urinary tract dysfunctions are assoc with MS?

Increased tone of bladder neck; retention
Irritability of detrusor muscle; frequency, nocturia, urgency, incontinence

15

What is used for fatigue management in MS?

Amantadine
Modafinil if sleepy (?)
Hyperbaric oxygen
Fatigue management via occupational therapists

16

How is MS diagnosed?

At least 2 episodes suggestive of demyelination
Dissemination of plaques in time and place
Alternative diagnoses excluded

17

What scans are done for the diagnosis of MS?

MRI - T2 weighted
FLAIR
CT ALWAYS BEFORE LP PERFORMED
Neurophysiology

18

What is the DDx of MS?

Vasculitis
Sarcoid (tend to have pulmonary and skin involvement along with arthralgia and uveitis)
Vascular disease
Structural lesion
Infection; HIV, syphilis, lyme disease
Metabolic disorder; B12/folate

19

What blood tests are routinely performed in the work up of potential MS?

PV, CRP, FBC
U+Es, eGFR
LFTs
Auto-antibody screen
Borrelia (lyme), HIV, syphilis
B12 and folate
Vit D

20

What is seen on CSF of those with MS?

Oligoclonal bands in 90+% of cases

21

What is the treatment of an acute relapse of MS?

Mild - symptomatic
Moderatie; oral methylprednisolone 500 mg for 5 days
Severe; IV methylprednisolone 1000 mg for 3 days

22

What are some common adverse effects of MS?

Osteoporosis
Pancreatitis
Diabetes
Hypertension
Psychosis
AVN of hip

23

What is the symptomatic tx for pyramidal dysfunction?

Physio
Occupational therapy
Anti-spasmodic agents
Don't always want to get rid of spasticity; if muscles very weak, the spasticity of them will be the only thing allowing the patients to stand up and walk

24

What are the anti-spasmodic agents used in spasticity?

PO; baclofen, tizanidine
Botulinum toxin
Intrathecal baclofen/ phenol

25

What are the treatments for the sensory symptoms assoc with MS?

Anticonvulsant e..g gabapentin
Anti-depressant; amitriptyline
Tens machine
Acupuncture
Lignocaine infusion

26

What is the treatment for lower urinary tract dysfunction?

Bladder training
Anticholinergics; oxybutynin
Desmopressin
Catheterisation

27

What are the 1st line disease modifying drugs used in MS?

Interferon beta; avonex, rebif, betaseron, extavia
Glitiramer acetate
Tecfidera, aubagio

28

What are the 2nd line disease modifying drugs used in MS?

Monoclonal Ab; tysabri, ocrevus
Fingolimod, cladrabine

29

What are the 3rd line disease modifying drugs used in MS?

Mitoxantrone, lemtrada
HSCT (stem cell transplantation)

30

What is a very serious side effect associated with tysabri?

If the patient is infected with JC virus; can activate and cause PML

31

What is PML?

Progressive multifocal leukoencephalopathy; fatal disease characterized by progressive inflammation of the white matter of the brain at multiple locations

32

What is the mode of action of tysabri?

Prevents leucocytes entering the BBB and therefore prevents autoinflammation