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Neurology > 3: Multiple Sclerosis > Flashcards

3: Multiple Sclerosis Flashcards

(54 cards)

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1
Q

Define multiple sclerosis

A

Chronic auto-immune condition characterised by demyelination of central nervous system

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2
Q

What age does MS occur

A

20-40 years

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3
Q

In which gender is MS more common

A

Female (3:1)

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4
Q

What is the stereotype for MS

A

Young Female

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5
Q

In which ethnicity is MS more common

A

White

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6
Q

What is a genetic RF for MS

A

HLADR2

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7
Q

What are three environmental RF for MS

A
  • Infection: EBV, HHV6
  • High Latitude
  • Vitamin D Deficiency
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8
Q

What infections increase risk of MS

A

EBV, HHV6

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9
Q

What are the 4 types of MS

A
  • Primary progressive
  • Relapsing-Remitting
  • Secondary progressive
  • Progressive -relapsing
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10
Q

What. % of MS is relapsing remitting

A

85

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11
Q

Explain relapsing-remitting MS

A

Attacks cause disability, then recovery in-between attacks. Individual nerve fully gains level of full function

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12
Q

Explain secondary progressive

A

Starts as relapsing-remitting and then attacks become continuous = secondary progressive

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13
Q

What is primary progressive

A

One continuous attack from the start

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14
Q

What is progressive-relapsing

A

Constant immune attack with worsening episodes super-imposed

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15
Q

What is a general symptom of MS

A

Lethargy

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16
Q

What are visual symptoms of MS

A
  • Optic Neuritis
  • Marcus Gunn Pupil
  • Intranuclear ophthalmoplegia
  • Uhthoff’s phenomenon
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17
Q

What is typically first manifestation of MS

A

Optic Neuritis

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18
Q

How does optic neuritis present

A

Loss of colour vision

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19
Q

What is Uhtoff’s phenomenon

A

Visions/Symptoms MS worsen in the head

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20
Q

What causes intranuclear ophthalmoplegia

A

Damage to medial longitudinal fasiculus

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21
Q

Explain intranuclear ophthalmoplegia

A

(Defect right eye)

  • When looking right eye movements normal
  • When looking left. Left eye can abduct. The right eye is unable to adduct. Difference in eye position causes diplopia
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22
Q

What pupil is present in MS

23
Q

Explain marcus gunn pupil

Study These Flashcards
A

RAPD:
During swinging light test.
Damage to afferent of affected eye
When shining light into affected eye will paradoxically dilate, opposed to constrict, as consensual reflex from other eye is stronger

24
Q

What are 3 sensory symptoms associated with MS

Study These Flashcards
A
  • Lhermitte’s sign
  • DCP
  • Bilateral trigeminal neuralgia
25
What is Lhermitte's sign
Electric shock type pain down the spine on flexing the neck
26
What motor symptoms are present in MS and why
Spastic weakness Hyper-reflexia Spasticity Upgoing plantar = due to UMN lesion
27
What are other signs of MS
- Urinary incontinence - Sexual dysfunction - Intellectural deterioration
28
What is Devic Syndrome
Transverse myelitis and optic atrophy
29
How does transverse myelitis present
Transverse myelitis (Loss Motor, Sensory and vision below lesion)
30
What causes Devic syndrome
Anti aquaporin 4 antibodies
31
What is Charles Bonnet Syndrome
When individual looses vision - develops very vivid hallucinations
32
What is pulfrich effect
Unequal eye latencies - causes straight lines to appear curved. Commonly presents as disorientation in traffic
33
What is argyll-robertson pupil
Small irregular pupils that can accommodate but do not respond to light
34
What criteria is used to diagnose MS
McDonal Criteria
35
What is required to diagnose MS using McDonal Criteria
Two lesions disseminated by space and time
36
What is criteria for 'attacks'
1h duration | 30d between attacks
37
What investigations are ordered for MS
Visual evoked potentials MRI LP
38
What is seen on visual evoked potentials
Delayed transmission
39
What is seen on MRI in MS
periventricular plaques
40
What is seen on LP in MS
Oilgoclonal bands
41
What lifestyle advice is given for MS
Smoking cessation Reduce stress Regular exercise
42
What is given for acute attacks in MS
Oral prednisolone
43
Explain oral prednisolone in MS
Helps reduce length of attacks it does not help an individual return to baseline
44
What are 4 disease modifying therapies in MS
- B-interferon - Glatamir acetate - Natalizumab - Fingolimod
45
What is MOA of natalizumab
a4b1 integrin antagonist
46
What is MOA of fingolimod
sphingosine-1-phosphate receptor modulator
47
What should all patients starting natalizumab be offered before and why
JC virus test. As it can be re-activated on treatment with natalizumab
48
What causes progressive multifocal leucoencephaloapthy
JC virus
49
How is fatigue managed in MS
Amantadine | CBT
50
How is spasticity managed in MS
Baclofen Gabapentin - Botox - Cannabis - Physio
51
How is bladder dysfunction assessed in MS
Bladder USS
52
If residual volume is more than 500ml what is offered
Intermittent self-catheterisation
53
If residual volume is less than 500ml what is offered for bladder dysfunction
Anti-cholinergic
54
How is oscillopsia managed in MS
Gabapentin

Neurology (26 decks)

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