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Neurology > Multiple Sclerosis > Flashcards

Flashcards in Multiple Sclerosis Deck (33)
1

Where in the NS does MS affect?

CNS
White matter tracts

2

What is the pathology associated with MS?

Demyelination of nerve axons due to autoimmune process causing inflammation of myelin sheath

3

What scan allows the visualisation of plaques of demyelination?

MRI

4

What is seen on MRI with axonal loss?

Black holes
Cerebral atrophy

5

What is the aetiology of MS?

Complex genetic inheritance
Associated with other autoimmune conditions
F>M
Commoner in temperate climates
VitD
EBV virus

6

What is the typical age of onset?

20-30s

7

How will MS usually present?

With a relapse = "Attack of demyelination"

8

What symptoms are observed in relapse of MS?

Optic neuritis
Sensory symptoms
Limb weakness
Brainstem diplopia, vertigo, ataxia

9

What is SYMPTOMS are observed with optic neuritis?

Subacute visual loss in one eye
Pain on eye movement
Loss of visual acuity
Swelling of optic disc

10

What are the differentials for optic neuritis?

Vit B12 deficiency
Wegeners granulomatosis
Local compression
Infection

11

If the cerebellum is involved in relapse, what likely symptoms will be observed?

Ataxia
Vertigo
Nystagmus

12

When can myelitis occur in MS?

Demyelination of the spinal cord

13

What symptoms will be observed with myelitis?

Sensory level (hyperasthesia)
Wekness/ upper neuron changes below level
Bladder & bowel problems

14

What are differentials for myelitis?

Tumour
Stroke
Infection

15

What is clinically isolated syndrome?

No further episodes after initial relapse

16

What is required for MS diagnosis?

Episodes of demyelination separated in space & time

17

What symptoms may be observed in relapses of MS?

Sensory loss
Optic nerve symptoms
Limb weakness
Diplopia
Vertigo
Ataxia
Sphincter disturbance

18

What signs may be observed on examination?

Hyperreflexia
Extensor plantars
Spasticity
Weakness
Sensory loss
Abnormal eye movements
Afferent pupillary defect

19

How many areas of demyelination equate to 1 relapse?

10 Areas

20

What other investigations may be done in addition to MRI?

Lumbar puncture - asses for oligoclonal bands in CSF
Bloods - look for inflammatory markers

21

What are some of the differentials for MS?

Sarcoidosis
Vascultitis
Infection (Lyme Disease)

22

What are the different types of MS?

Relapsing - remitting (RRMS) -85%
Primary progressive (PPMS)
Secondary progressive (SPMS)

23

What are some good prognostic indicators for MS?

Female
Presenting with optic neuritis
Long interval btw 1st & 2nd episodes
Few relapse in first 5 yrs

24

What are some bad prognostic indicators for MS?

Male
Presenting in older age
Multifocal S & Ss
Motor symptoms

25

What are the characteristics of PPMS?

Presents in 50s/60s
No relapses
Spinal symptoms
Bladder symptoms
Prognosis poor
M:F

26

What diseases are associated with neuromyelitis optic spectrum disorders?

Devics Disease =
Optic neuritis
Myelitis
Aquaporin-4 antibodies

27

How can you treat acute relapse?

Look for underlying infection
Oral or IV prednisolone

28

How do you treat further relapses?

Look for underlying viral infection
Vaccine is advised

29

What is the 1st line therapies for disease modifying meds?

Beta-interferons
Glatiramer - these are all injectable

Teriflunomide
Dimethyl fumarate

30

What do 1st line therapies prevent?

Reduce relapses by 1/3
No effect on disease progression

31

What is a 2nd line disease modifying treatment?

Natalizumab
Fingolimod

32

What are some of the risk factors associated with immunosuppression in MS?

Progressive Multifocal Leukencephalopathy (PML)
Activation of JC virus

33

What other symptomatic meds bay be given?

Antispasmodics (spasticity)
Anticholinergics (urinary)
Laxative (constipation)
Gabapentin (dysaesthesia)
Depression - CBT
Cognition - memory aid
Speech & swallowing - SALT