MS Flashcards
What is Lhermitte’s sign? In what conditions can it be present?
Cervical flexion causes electric shock in the trunk/limbs
MS, cervical spondylosis, cord tumours and subacute combined degeneration of the cord
How are acute attacks treated?
3-5 day of IV pulse methylprednisolone, 1g/day
(can sometimes use oral)
How is MS diagnosed?
Clinical diagnosis - McDonald criteria
Requires lesions disseminated in time and space
MRI is sensitive not specific for plaques
In secondary progressive MS do patient still get acute attacks of neurological deficit?
Can do but not necessarily
What are some common first presenting symptoms of MS?
Optic neuritis
Transverse myelitis
Brainstem/cerebellar signs
How does MS present clinically?
Usually monosymptomatic
Can be:
Unilateral optic neuritis (pain on ete movement and rapid decrease in central vision)
Numbness or tingling in the limbs
Leg weakness
Brainstem or cerebellar symptoms
What is the natural history of MS?
Relapsing and remitting symptoms as demyelination heals poorly.
Prolonged demyelination causes axonal loss and clinically progressive symptoms
How is MS managed?
Methylprednisolone, 1g 3/7 for acute relapses
Interferons reduce relapse by 30% in active relapsing and remitting
Alemtuzumab and Natalizumab in relapsing-remitting
Azathioprine may be as good as interferons in relapsing-remitting
Where are plaques typically located?
Corpus callosum
Symmetric periventricular
Internal capsule
Brainstem/Spinal cord
How can a MS relapse present?
Optic neuritis
Muscle weakness
Parasthesia
Fatigue
Cognitive dysfunction
Sexual dysfunction
Bladder/bowel dysfunction
Cerebellar symptoms
Lateral diplopia
Heat intolerance
Trigeminal neuralgia
Pain
Bipolar disoroder
Depression
Is complete loss of vision a standard feature of optic neuritis?
No
Vision loss ranges from mild to profound
What Ix can be performed in MS?
MRI of brain and spinal cord looking for lesions, particularly periventricular, cerebellar and in the cervical spine
LP for oligoclonal IgG bands which are present in 80% of cases however are non-specific and reflect only Ig production in response to ag
What are some DDx of MS?
Vasculitis
Friedreich’s ataxia
CNS sarcoidosis
Behcet’s syndrome
SLE
What is MS?
Discrete plaques of demyelination occur at multiple CNS sites due to T-cell mediated immune response
What are some common symptoms of MS?
Fatigue
Walking problems
Bowel and bladder problems
Depression
Pain
Cognitive problems
