Multiple Sclerosis

Question 1

MS

What is the pathophysiology of it?

Answer 1

• T cells enter the CNS, resulting in acute inflammatory demyelination via type IV hypersensitivity.

Question 2

MS

What are some typical features of MS?

Answer 2

• optic neuritis
• diplopia
• transverse myelitis
• clumsiness

Question 3

MS

Tests

Answer 3

• mri
• lumbar puncture
• visual evoke potentials

Question 4

MS

Answer 4

McDonald’s criteria

Question 5

MS

How to manae acutely and as long-term management.

Answer 5

• look for infection and steroids
• beta-interferon

Question 6

MS

What is it?

Answer 6

idiopathic, immune-mediated demyelinating disease of the central nervous system (CNS), where there is loss of axons in discrete areas, called plaques

Question 7

MS

What are some risk factors?

Answer 7

• female
• FHx
• autoimmune disorders (particularly those with HLA DQ6 variants).

Question 8

MS

What factors might trigger MS?

Answer 8

• Low vitamin D levels – making the disease more prevalent in countries that are further north or south of the equator
• EBV or HHV6 infections
• Smoking

Question 9

MS

What are the main characteristics of the disease?

Answer 9

The main characteristics of this disease are:
* Demyelination
* Acute inflammation around the demyelinated areas
* Plaque formation after incomplete healing

Question 10

MS

What are 4 main patterns associated with MS?

Answer 10

• relapsing-remitting (85%)
• secondary progressive
• primary progressive
• progressive relapsing

Question 11

MS

How do pts typically present?

Answer 11

recurrent neurological deficits that come and go
- 75% of patients will present with one major deficit (optic neuritis -> most common)
- 25% -> combination

Question 12

MS

Damage to these areas can cause what signs/symptoms?

• Motor cortex
• Frontal lobe
• Parietal lobe
• Temporal
• Optic nerve
• Cerebellum
• Brainstem
• Spinal cord

Answer 12

Motor cortex – hypertonia, hyperreflexia
Frontal lobe – mild cognitive issues, disinhibition
Parietal lobe – visuospatial problems
Temporal – poor memory
Optic nerve – optic neuritis, oscillopsia
Cerebellum – cerebellar syndrome
Brainstem – CN III dysfunction, internuclear ophthalmoplegia, bulbar dysfunction
Spinal cord – sensory dysfunction, UMN hemiplegia, autonomic dysfunction, neuropathic pain

Question 13

MS

How is MS diagnosed?

Answer 13

Diagnosis of MS should be made with a history of at least 2 relapses + clinical evidence of 2 or more lesions, or evidence of 1 lesion plus a previous history of relapse.

Question 14

MS

How do we investigate?

Answer 14

• MRI
• CSF analysis
• Visual evoked potentials

Question 15

MS

What might we see in an MRI?

Answer 15

– White matter plaques can show a lesion, especially in the corpus callosum, periventricular regions, brainstem and cerebellum. However, these patches can also be found in healthy patients, so cannot use MRI alone for MS diagnosis.

Question 16

MS

What might we see in CSF?

Answer 16

– oligoclonal bands of IgG can support the diagnosis

Question 17

MS

What might we see in visual evoked potentials?

Answer 17

– shows decreased duration velocity along axons