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MS Flashcards

1
Q

What is the primary pathology of MS?

A

Multiple focal sites of demyelination in the CNS

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2
Q

What is the cause of demyelination in MS?

A

T-cell mediated immune response

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3
Q

What is the trigger of the immune response that causes MS?

A

Currently unknown

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4
Q

Does the demyelination of MS ever heal?

A

Yes, but not permanently

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5
Q

What is the typical temporal pattern of MS?

A

Relapse and remission

Remissions end up getting less and less complete however in progressing disease

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6
Q

Where in the world have the highest rates of MS?

A

Temperate areas

England, Scotland

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7
Q

T/F MS is more common in blacks/asians

A

F

Rarer in blacks and asians

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8
Q

If a person lives in a geographical area that has a high risk of MS, then moves to a low risk area and has children, what happens to the risk profile of them and their children?

A

Their risk will remain high because you take your risk of MS with you

Children acquire the risk of where they settle, so their risk would be low

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9
Q

If a person lives in a geographical area that has a high risk of MS, then moves to a low risk area and has children, what happens to the risk profile of them and their children?

A

Their risk will remain high because you take your risk of MS with you

Children acquire the risk of where they settle, so their risk would be low

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10
Q

What is the average age of onset of MS?

A

30 years old

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11
Q

Is MS more common in males or females?

A

Females

3:1

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12
Q

What role does Vit D seem to play in MS?

A

Circulating Vit D status relates to improved symptoms and prevention of MS

Early exposure to sunlight/vit D seems to be important, hence the geographical areas of high risk where sunlight exposure is low

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13
Q

What are some major sensory features of MS?

A

Dysaesthesia

Paraesthesia

Decreased vibration sense

Trigeminal neuralgia

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14
Q

What are some major motor features of MS?

A

Spastic weakness

Transverse myelitis (loss of motor, sensory, autonomic etc below the level of a lesion)

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15
Q

Does MS lead to erectile dysfunction?

A

Yes

As well as anorgasmia

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16
Q

Does MS lead to urine or faecal retention?

A

Yes

Urinary retention and constipation

17
Q

What are some ophthalmological features of MS?

A

Optic neuritis

Diplopia

Pupillary defects

18
Q

What are some cerebellar features of MS?

A

Trunk/limb ataxia

Intention tremor

Scanning (ie monotonous) speech

Falls

19
Q

What are some major cognitive features of MS?

A

Decreased executive functioning

Decreased mood, depression and isolation

20
Q

What conditions other than MS can cause hyperdense lesions in the CNS?

A

SLE

Sjogren syndrome

Polyarteritis nodosa

Syphilis

21
Q

What conditions other than MS can cause hyperdense lesions in the CNS?

A

SLE

Sjogren syndrome

Polyarteritis nodosa

Syphilis

22
Q

In what clinical situation would you almost not consider that something other than MS could be causing the symptoms?

A

young adult who has had two or more clinically distinct episodes of central nervous system dysfunction with at least partial resolution

Diagnostic difficulties arise in patients who have atypical presentations, monophasic episodes, or progressive illness

23
Q

What are some clinical features that would make you begin to consider that the clinical syndrome was not MS?

A

Well demarcated spinal cord lesion level, below which are found all of the neurological symptoms

Patient is >60 or

24
Q

What are some major DDx’s for MS?

A

Transverse myelitis

Neuromyelitis optica

Acute disseminated encephalomyelitis (ADEM)

25
Q

What is the major gist of the McDonald criteria for MS diagnosis?

A

Dissemination of lesions in time and space

26
Q

If a patient with ?MS only has had one attack with two clinical lesions, what additional data is required by the McDonald criteria?

A

Dissemination in time

Thus, basically just a 2nd clinical attack with 2 clinical lesions

Or MRI data

27
Q

If a patient with ?MS only has had one attack with two clinical lesions, what additional data is required by the McDonald criteria?

A

Dissemination in time

Thus, basically just a 2nd clinical attack with 2 clinical lesions

Or MRI data

28
Q

If a patient with ?MS only has had one attack, and only with one clinical lesion, what additional data is required by the McDonald criteria?

A

Dissemination in both time and space

Thus, another clinical attack and evidence that there are multiple lesions on MRI and +ve CSF

29
Q

Are T2 hyperdense lesions in MS more common in the thalamus or periventricularly?

A

Periventricular

Thalamic lesions are more common in ADEM

30
Q

What does an LP look for in MS?

A

Oligoclonal IgG bands on electrophoresis that are not present in serum

31
Q

What does an LP look for in MS?

A

Oligoclonal IgG bands on electrophoresis that are not present in serum

NMO-IgG ab’s in CSF are highly specific for neuromyelitis optica (NMO; Devic’s syndrome)

32
Q

What is the primary drug used to shorten the time to remission in MS relapses?

A

Methylprednisolone

33
Q

How often can you give an MS patient methylprednisolone?

A

Very sparingly

Maximum of twice per year

34
Q

Does methylprednisolone change the overall prognosis of MS?

A

No

Only shortens relapses

35
Q

What is the role of interferon in MS treatment?

A

Decreases relapses by 30% in active disease

Decreases lesion accumulation on MRI

36
Q

What are some serious side effects of interferon treatment?

A

Flu-like symptoms

Depression

Abortion

37
Q

What do you know about azathioprine in the treatment of MS?

A

May be as effective as interferons but much cheaper (20x)

38
Q

What is natalizumab (Tysabri)?

A

A monoclonal antibody which allows immune cells to cross the BBB

Decreases MS relapses by 2/3rds and reduces MRI lesions by 90%

cc: neuro (8 decks)

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